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  • If pneumatic dilation is not enough efficient for post fundoplication dysphagia, is Per Oral Endoscopic Myotomy a good answer to manage it?

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If pneumatic dilation is not enough efficient for post fundoplication dysphagia, is Per Oral Endoscopic Myotomy a good answer to manage it?
  1. Antoine Debourdeau1,2,
  2. Véronique Vitton3,
  3. Marc A Barthet4,
  4. Jean-Michel Gonzalez5
  1. 1 Endoscopy Unit, CHU Montpellier, Montpellier Univ, Montpellier, France
  2. 2 Medicine Faculty, Montpellier Univ, Montpellier, France
  3. 3 Gastroenterology Department, Assistance Publique Hopitaux de Marseille, Marseille, France
  4. 4 Gastroenterology, Assistance Publique Hopitaux de Marseille, Marseille, France
  5. 5 Gastroenterology, Hopital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France
  1. Correspondence to Dr Antoine Debourdeau, Department of Hepatogastroenterology, CHU Montpellier, Montpellier 34095, France; a-debourdeau{at}chu-montpellier.fr

https://doi.org/10.1136/gutjnl-2021-324238

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    We read with interest the article by Schuitenmaker et al 1 that evaluated oesophageal pneumatic dilation (PD) for persistent dysphagia after antireflux surgery (ARS).

    The authors concluded that PD is not more effective than sham procedure in patients with persistent dysphagia after laparoscopic fundoplication.

    The therapeutic target of PD is the esogastric junction (EGJ) and its effect is theoretically explained by mechanical forces applied on an EGJ obstacle, being either cardial muscular in achalasia or extrinsic valve after antireflux fundoplication. But most of the patients included in the study (76%) did not have an EGJ outflow obstruction (EGJOO).

    The realisation of an antireflux valve can lead to the development of inefficient oesophageal motility in nearly 20% of cases2 and the study of Schuitenmake et al reinforces the idea that post-ARS dysphagia is not necessarily related …

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    Footnotes

    • Twitter @AntoineDebourd1

    • Contributors AD wrote the manuscript. VV, MAB and J-MG made critical revisions of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; internally peer reviewed.