Longitudinal myotomy of the oesophagus under thoracoscopy, a successful alternative treatment of diffuse oesophageal spasm

History and admission findings: A 55-year-old woman had for 5 years been su ffering from severe burning thoracic pain. She had typical risk factors for cardiovascular disease, namely hypertension, chronic smoking, obesity and hypercholesterolaemia. She had been hospitalized several times for suspecte d myocardial infarction, but coronary heart disease had been excluded by ca rdiac examination, including angiocardiography. The only contributory admis sion finding was epigastric pain on pressure. Investigation: Gastroscopy revealed a nonerosive duodenitis and chronic ant ral gastritis. The cardia was tightly closed and there were no signs of ref lux oesophagitis. Manometry in the oesophagus showed frequent simultaneous contractions and marked increase in pressure amplitude, predominantly in th e distal segment, indicating diffuse oesophageal spasms. Treatment and course: Drug treatment with calcium channel blockers gave onl y brief relief from the thoracic pain. But longitudinal oesophageal myotomy via thoracoscopy brought about complete pain relief, which has now persist ed for 3 years. Conclusion: Thoracoscopic longitudinal oesophageal myotomy can provide a th erapeutic alternative in patients with oesophageal spasms when drug therapy and pneumatic oesophageal dilatation have failed.