Diffuse spasm of the esophagus. Clinical manometric, and surgical considerations.

Extended esophagomyotomy was performed on 11 patients with diffuse spasm of the esophagus (DSE). Preoperative and postoperative clinical, manometric, and roentgenographic findings are reviewed. Preoperative manometry performed in all patients disclosed a mean deglutitive pressure of 70 mm. Hg in the diseases areas and indicated the required length of myotomy. The lower esophageal sphincter (LES) was within normal limits in most instances, with a mean amplitude of 20 mm. Hg, and its exclusion from the myotomy eliminated the need for additional antireflux procedures. Postoperative manometry in 10 patients disclosed a 70 percent reduction in deglutitive pressures in the myotomized segments, and the mean LES amplitude of 13 mm. Hg remained within the normal range (10 to 20 mm. Hg). Ten of the 11 patients were clinically improved, and postoperative reflux developed in only one patient. These results support the continued use of extended esophagomyotomy in selected patients with DSE and suggest that exclusion of the LES from the myotomy affords satisfactory antireflux protection without ancillary sphincter-enhancing maneuvers.