Intraoperative Esophagogastroduodenoscopy During Heller Myotomy: Evaluating Guidelines

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Surgical Outcomes

Background:

• National guidelines recommend routine intraoperative esophagogastroduodenoscopy (EGD) during laparoscopic Heller myotomy (LHM).
• The clinical utility of routine EGD in LHM is not well-established.
• This study evaluates the impact of intraoperative EGD on outcomes following LHM.

Purpose of the Study:

• To determine if routine intraoperative esophagogastroduodenoscopy (EGD) improves outcomes after laparoscopic Heller myotomy (LHM).

Main Methods:

• Retrospective review of patients undergoing LHM at a single center.
• Comparison of outcomes between patients who had and did not have intraoperative EGD.
• Analysis included mucosal perforations, myotomy adequacy, and postoperative complications.

Main Results:

• 46 patients underwent EGD, while 15 did not.
• Mucosal perforations occurred in 4% of the EGD group vs. 20% of the non-EGD group (p=0.06).
• Failed myotomy rates were similar between groups (11% with EGD vs. 7% without EGD; p=0.64).

Conclusions:

• Intraoperative esophagogastroduodenoscopy (EGD) does not demonstrate a significant benefit in improving outcomes for laparoscopic Heller myotomy (LHM).
• The findings support a selective rather than routine approach to using EGD during LHM.
• Routine EGD may not be necessary for assessing mucosal perforations or myotomy adequacy in LHM.