LONG ESOPHAGEAL MYOTOMY WITH A FUNDIC PATCH PROCEDURE FOR TREATING DIFFUSE ESOPHAGEAL SPASM - REPORT OF A CASE

A diagnosis of diffuse esophageal spasm (DES) based on radiological an d manometric studies was made in a 70-year-old man who presented with severe dysphagia, vomiting, and spontaneous chest pain. The manometric studies revealed a simultaneous onset of high amplitude contractions and a hypertensive lower esophageal sphincter (LES) that was well rela xed in response to deglutition, in contrast to the incomplete relaxati on seen in achalasia. Because his dysphagia was so severe and did not respond to pneumatic dilatation, the patient was treated by a long eso phageal myotomy with a full thickness incision through the LES and muc osa, adding a Thal-Hatafuku procedure. The patient made a good postope rative recovery and has since been eating normally without any further dysphagia or chest pain. Good manometric and radiological results hav e been obtained in this patient during 5 years of follow-up.