Long-Term Quality of Life in Achalasia Patients After Esophagectomy: A Single Center Experience

Abstract

Introduction: Achalasia is a chronic motility disorder of the esophagus with difficult to manage symptoms. Despite multi-modal therapies, some patients progress to end-stage disease requiring esophagectomy. Quality of life (QOL) has not been fully described in this population. Methods: A cross-sectional QOL study was performed on a cohort of end-stage achalasia patients who underwent an esophagectomy (2010-2020). Patients who met inclusion criteria were contacted by phone in 2021 to complete GIQLI and OES-18 questionnaires. Descriptive statistics were performed. Results: Of 14 patients who met inclusion criteria, 9 (64.3%) completed the QOL questionnaires. Mean age was 53-years, and the majority were white (88.9%) women (63.7%). Prior to esophagectomy, management of achalasia included Botox (33.3%), dilation (66.7%), and Heller myotomy (100%). All patients reported dysphagia and 88.9% reported regurgitation prior to esophagectomy. All patients underwent a minimally invasive surgical approach. At the time of QOL surveillance, the mean time from operation was 66 months. The mean GIQLI score in this population was 97 (Max 144), compared to previously reported scores of 126 in a healthy population and 119 after Heller myotomy. Only ICU and hospital LOS had a statistically significant association with poorer GIQLI scores. The results of the OES-18 showed higher median severity scores for reflux, dry mouth and trouble with coughing. Conclusions: Even after esophagectomy for end stage achalasia, symptoms can be persistent and impact QOL. While some patients may benefit from esophagectomy, future research should aim to identify which patients will benefit the most from this operation.