Long-term results of laparoscopic Heller-Dor for esophageal-gastric junction outflow obstruction: a prospective comparative study

Background: The aim of this prospective, controlled study was to assess the 5-year follow-up of laparoscopic Heller-Dor (LHD) in patients with esophago-gastric junction outflow obstruction (EGJOO), compared with achalasia patients (ACH). The management of EGJOO reflects the experience gained with esophageal achalasia, for which LHD has been proven to be an effective long-term treatment. Prospective long-term results of LHD in EGJOO patients are still lacking. Materials and methods: Patients with diagnosis of idiopathic EGJOO referred for dysphagia or food-regurgitation, treated with LHD, were enrolled and then followed prospectively for 5 years. During the follow-up, patients were evaluated with Eckardt score (ES), Barium-swallow X-ray, high-resolution manometry (HRM), 24-hour pH-monitoring and endoscopy. Primary outcome was therapeutic success (ES ≤ 3 or no additional treatment). Results: The study involved 150 patients: 25 in the EGJOO group and 125 in the ACH group. After 5 years, there was no significant difference in success rate: 90.5% in the EGJOO group, 87.5% in ACH stage I - pattern I, 91.6% in ACH stage I - pattern II and pattern III ( P = 0.94). The ES and all the HRM parameters were similar in all groups. Moreover, the screening endoscopy and the 24-hour pH-monitoring showed a similar postoperative acid exposure in all groups. Conclusion: This is the first study based on prospective data to assess the long-term outcome of LHD in patients with EGJOO. After at least 5 years of follow-up, LHD has a comparable success rate in both EGJOO and achalasia patients and can be proposed as a safe and effective treatment for EGJOO patients.