Can Heller's (esophageal myotomy) myotomy lead to portal hypertension?

From the Guidelines

No, Heller's myotomy (esophageal myotomy) does not lead to portal hypertension. Heller's myotomy is a surgical procedure specifically designed to treat achalasia, a motility disorder of the esophagus where the lower esophageal sphincter fails to relax properly. The procedure involves cutting the muscle fibers of the lower esophageal sphincter to reduce pressure and improve food passage into the stomach. Portal hypertension is an entirely different condition characterized by increased blood pressure in the portal venous system, typically caused by liver cirrhosis, blood clots in the portal vein, or other conditions affecting liver blood flow. These two conditions involve completely separate anatomical systems - Heller's myotomy affects the esophageal musculature while portal hypertension involves the hepatic portal circulation. The complications of Heller's myotomy may include gastroesophageal reflux, perforation, or recurrent dysphagia, but there is no physiological mechanism by which this esophageal procedure would affect portal venous pressure or lead to portal hypertension, as supported by recent clinical practice updates 1. Additionally, the management of conditions like portal hypertensive gastropathy, which is associated with portal hypertension, involves addressing the underlying cirrhosis and portal hypertension, and does not involve esophageal procedures like Heller's myotomy 1. Therefore, based on the most recent and highest quality evidence, Heller's myotomy is not associated with portal hypertension. Key points to consider include:

• The separate anatomical systems involved in Heller's myotomy and portal hypertension
• The lack of physiological mechanism by which Heller's myotomy would affect portal venous pressure
• The complications of Heller's myotomy, which do not include portal hypertension
• The management of portal hypertension and related conditions, which does not involve esophageal procedures like Heller's myotomy.

From the Research

Heller's Myotomy and Portal Hypertension

• There is no direct evidence in the provided studies to suggest that Heller's myotomy leads to portal hypertension 2, 3, 4, 5, 6.
• The studies primarily focus on the outcomes of Heller's myotomy for achalasia, including its efficacy, complications, and comparison with other treatments such as pneumatic dilation and peroral endoscopic myotomy.
• None of the studies mention portal hypertension as a potential complication or consequence of Heller's myotomy.

Complications of Heller's Myotomy

• The studies do report various complications associated with Heller's myotomy, including:
  • Intraoperative complications such as GI perforations 2, 6
  • Postoperative complications such as severe dysphagia and pulmonary complications 2
  • Failure of myotomy, defined by persistent or recurrent severe symptoms, or need for additional therapy 2, 4
• However, portal hypertension is not mentioned as a complication in any of the studies.

Conclusion Not Applicable

As per the instructions, a conclusion section is not to be included. The information provided is based on the available evidence and does not speculate on the relationship between Heller's myotomy and portal hypertension beyond what is directly stated in the studies.