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  1. Achalasia cardia: an atypical presentation in an uncommon disorder. [Abstract]
    Ganesananthan S, Kew ST, Ngau YY, Ong J
    Med J Malaysia, 2001;56 Suppl A:46-46.
    Matched MeSH terms: Esophageal Achalasia
  2. Achalasia cardia presenting with haemetemesis. [Abstract]
    Ganesananthan S, Ngau YY, Menon J, Kew ST
    Med J Malaysia, 2002;57 Suppl A:47.
    Matched MeSH terms: Esophageal Achalasia
  3. Bronchiectasis as a sequelae to achalasia [Abstract]
    Ganesananthan S, Ngau YY
    Med J Malaysia, 2002;57 Suppl A:51-51.
    Matched MeSH terms: Esophageal Achalasia
  4. A modification of pneumatic dilation technique. [Abstract]
    Ganesananthan S, Rajvinder S, Kiew KK, Melvin R
    Med J Malaysia, 2004;59 Suppl C:51.
    Background: Based on studies and some clinical practice pneumatic dilatation utilizing the widely available wire guided polyethylene pneumatic dilator system using a 30mm balloon inflated for 15 seconds upon loss of waist noted (during fluoroscopy) at 7 to 10psi obtains optimal disruption of the lower esophageal sphincter. We employed this technique till August 2001 without any complications (notably perforation) with good clinical outcome and durability.
    Aims: To study the efficacy of pneumatic dilatation with the pneumatic balloon dilated only till loss of waist.
    Materials and Methods: A total of 10 treatment naïve achalasia patients enrolled from August 2001 till July 2002 were dilated till loss of waist and the outcome and durability was compared with our historical controls.
    Findings: A total of 10 patients with age 45±18 (range 22-67) years with 8 females: 2 males and 5 Malays: 5 Chinese with 3 patients with megaoesophagus underwent pneumatic dilatation using a 30 mm Rigiflex® pneumatic dilator till loss of waist was noted during fluoroscopy at 7psi and the balloon deflated immediately. All the patients reported symptomatic improvement in dysphagia, regurgitation and demonstrated a 3-12 month post procedural weight gain of 6±5 (range: 1-15) kg. One patient required a second dilatation only after 13 months. All the remaining patients remain well till today after the initial single dilatation. The durability of the dilatation was 27±7 months (range: 13-33) months. There were no complications noted. There were no complaints of excessive reflux. This data was compared with our historical control (patients before August 2001), i.e. the pneumatic dilator inflated for 15 seconds upon loss of waist, and there was no difference in clinical outcome, or the durability of dilatation or the duration of stay post procedure.
    Conclusion: Forceful disruption of the lower esophageal sphincter utilizing the pneumatic dilator is effective but is associated with a 1-5% risk of perforation. We obtained identical results without loss of clinical improvement or durability utilizing our technique compared to the traditional method. Since August 2001 all our dilatations were performed in our unit utilizes this simplified method. We have yet to report a perforation after pneumatic dilatation.
    Matched MeSH terms: Esophageal Achalasia
  5. A review of 10 patients with achalasia and megaesophagus: Hospital Kuala Lumpur experience. [Abstract]
    Ganesananthan S, Rajvinder S, Kiew KK
    Med J Malaysia, 2005;60 Suppl A:48.
    Introduction: Megaesophagus is defined as an esophagus measuring 8cm or larger on the barium swallow examination in a patient with Achalasia cardia. Its existence defines a late stage of achalasia and therapy will include an esophagectomy in its management. The latter carries a high morbidity and mortality.
    Materials and Methods: We reviewed retrospectively all treatment naïve patients with Achalasia from 1st January 2000 and identified 10 patients with megaesophagus and these patients were analysed.
    Findings: The average presenting age is 52±15 (range 20-73) years with 4 males: 6 females with 5 Malays:3 Chinese:2 Indians. The duration of illness before diagnosis was 7±5 (range 1-16) years. All patients had dysphagia, regurgitation and weight loss. All 10 patients demonstrated aperistalsis but interestingly 8 patients failed Lower Esophageal Sphincter (LES) intubation during Standard Esophageal Manometry due to coiling of the catheter. Failure to elicit Failure of LES relaxation translates as a high technical failure of manometry (80%) in the diagnosis of Achalasia. A confident diagnosis of Achalasia was made on barium swallow in 9 cases (90%). All 10 patients underwent pneumatic dilatation. Eight patients required only single dilatation. However two patients required two dilatations. The durability of the twelve pneumatic dilatation 27±13 (Range: 9-44) months with good symptomatic relieve and an objective post procedural weight gain of 10±6 (range:1-19) kg over a period of 3-12 months. There was no complications noted post procedure.
    Conclusion: In advanced cases of achalasia, barium swallow is superior to manometry for obtaining the diagnosis. Pneumatic dilatation is an effective and safe procedure for patients with megaesophagus.
    Matched MeSH terms: Esophageal Achalasia
  6. The Kuala Lumpur Hospital Achalasia Series. [Abstract]
    Ganesananthan S, Kew ST, Ngau YY, Melvin R
    Med J Malaysia, 2002;57 Suppl D:FP4-3.
    Matched MeSH terms: Esophageal Achalasia
  7. Fulltext Bridging the gap between advancements in the evolution of diagnosis and treatment towards better outcomes in achalasia
    Chuah SK, Lim CS, Liang CM, Lu HI, Wu KL, Changchien CS, et al.
    Biomed Res Int, 2019;2019:8549187.
    PMID: 30881999 DOI: 10.1155/2019/8549187
    Over the past few decades, there was an encouraging breakthrough in bridging the gap between advancements in the evolution of diagnosis and treatment towards a better outcome in achalasia. The purpose of this review is to provide updated knowledge on how the current evidence has bridged the gap between advancements in the evolution of diagnosis and treatment of esophageal achalasia. The advent of high-resolution manometry and standardization based on the Chicago classification has increased early recognition of the disease. These 3 clinical subtypes of achalasia can predict the outcomes of patients, and the introduction of POEM has revolutionized the choice of treatment. Previous evidence has shown that laparoscopic Heller myotomy (LHM) and anterior fundoplication were considered the most durable treatments for achalasia. Based on the current evidence, POEM has been evolving as a promising strategy and is effective against all 3 types of achalasia, but the efficacy of POEM is based on short- and medium-term outcome studies from a limited number of centers. Types I and II achalasia respond well to POEM, LHM, and PD, while most studies have shown that type III achalasia responds better to POEM than to LHM and PD. In general, among the 3 subtypes of achalasia, type II achalasia has the most favorable outcomes after medical or surgical therapies. The long-term efficacy of POEM is still unknown. The novel ENDOFLIP measures the changes in intraoperative esophagogastric junction dispensability, which enables a quantitative assessment of luminal patency and sphincter distension; however, this technology is in its infancy with little data to date supporting its intraoperative use. In the future, identifying immunomodulatory drugs and the advent of stem cell therapeutic treatments, including theoretically transplanting neuronal stem cells, may achieve a functional cure. In summary, it is important to identify the clinical subtype of achalasia to initiate target therapy for these patients.
    Matched MeSH terms: Esophageal Achalasia/diagnosis*; Esophageal Achalasia/pathology; Esophageal Achalasia/therapy*
  8. Achalasia registry: the Kuala Lumpur Hospital experience. [Abstract2]
    Ganesananthan S, Rajvinder S, Anil R, Kiew KK, Ng KL, Rosaida MS, et al.
    Med J Malaysia, 2004;59 Suppl C:48.
    Background: Achalasia cardia is an uncommon disease that is often detected late and is associated with significant morbidity. It is a primary esophageal motility disorder diagnosed based on a good history, barium swallow, upper endoscopy and a standard esophageal manometry.
    Materials and Methods: We reviewed complete available records of treatment naïve patients with achalasia cardia from 1st January 2000 till April 2004.
    Results: A total of 40 patients, with average presenting age at 44±16 (range 19-73) years with 14 males: 26 females with 20 Malays: 15 Chinese: 5 Indians, were suitable for further analysis. The classical symptom of dysphagia to liquids and solids were noted in all cases (100%). These patients learnt that water and sometimes-aerated drinks aid in flushing food down. Symptoms of regurgitation (36 patients-90%), heartburn (15 patients-37.5%), weight loss (10 patients–25%), nocturnal cough (16 patient-40%), retrosternal chest discomfort (2 patient-5%) and hemetemesis (2 patient-5%) was noted. One patient had aspiration pneumonia and another had concomitant active pulmonary tuberculosis and 8 had concomitant constipation (20%). In this series the duration of illness before diagnosis was 5±6 (range
    0.3- 30) years and their presenting weight was 53±13 (range 33-82) kg. Barium swallow diagnosed achalasia in 27 patients (67.5%) and a dysmotility disorder in 7 cases (17.5%). There were 10 patients with mega-esophagus and two had epiphrenic diverticulum. There was no pseudoachalasia. Standard esophageal manometry, performed in 36 cases, demonstrated aperistalsis with one vigorous achalasia. The manometric assembly failed to pass through the sphincter in 14 cases and hence LOS assessment was not possible. Four cases demonstrated normal LOS pressure but demonstrated incomplete relaxation (normotensive achalasia). Pneumatic dilatation was performed in 38 newly cases without any complications with excellent symptomatic relief and a 3-12 month post procedural weight gain of 7±5 (range: 0-19) kg. Six patients required a second dilatation and another required two further dilatation. The durability of the total 45 pneumatic dilatations during this short study period was excellent at 24±12 (range 2-48) months.
    Conclusion: A primary esophageal motility disorder must be excluded in any patients who present with dysphagia, with or without regurgitation and a "normal" upper endoscopy. Achalasia is not uncommon, often delayed in diagnosis and has a varied presentation. Although there is no cure for achalasia, but early detection and treatment certainly relieves symptoms and prevents complications. Pneumatic dilatation in our center has excellent durability without any complications.
    Matched MeSH terms: Esophageal Achalasia
  9. Achalasia registry: the Kuala Lumpur Hospital experience. [Abstract]
    Ganesananthan S, Kew ST, Ngau YY, Ong J, Matvinder S, Liew SH, et al.
    Med J Malaysia, 2001;56 Suppl A:47.
    Matched MeSH terms: Esophageal Achalasia
  10. The diversity of achalasia cardia: the five years Kuala Lumpur Hospital series. [Abstract]
    Ganesananthan S, Kiew KK, Shanti P, Hajariah H, Liew SH
    Med J Malaysia, 2005;60 Suppl A:35.
    Background: Achalasia cardia, not an uncommon disease, is diagnosed based on a good history, upper endoscopy, barium swallow, and standard esophageal manometry, is often diagnosed late and best care is delayed.
    Materials and Methods: Complete records of treatment naïve patients with achalasia from 1st January 2000 till 20th November 2004 were reviewed.
    Results: A total of 42 patients, with average presenting age at 45±17 (range 19-83) years with 15 males:27 females with 22 Malays:15 Chinese:5 Indians, were analysis. Compared to our upper endoscopy attendees, there is a trend towards a younger age group (p>0.05) but clearly demonstrating a female preponderance (p<0.005) and towards the Malays but sparing the Indians (p< 0.05). The classical symptom of dysphagia was noted in all cases (100%). Regurgitation in 37 patients (88%), heartburn in 15 patients (36%), weight loss in 10 patients, nocturnal cough in 16 patient, retro-sternal chest discomfort in 2 patients and hemetemesis in 2 patient. One patient presented with aspiration pneumonia and another had concomitant active pulmonary tuberculosis and 9 had concomitant constipation (21%). The duration of illness before diagnosis was 66±90 (range 3-360) months and their presenting weight was 52±12 (range 33-82) kg. Barium swallow examination confidently diagnosed achalasia in 28 patients (67 %). The remaining was marked as dysmotility disorder (7 cases), possible carcinoma of the esophagus (in 2 patients) and dysmotility with possible achalasia (in 5 patients). Ten had mega-esophagus and two had epiphrenic diverticulum with no pseudo-achalasia. Standard esophageal manometry, performed in 39 cases, all demonstrated aperistalsis with one vigorous achalasia. The manometric assembly failed to pass through the
    sphincter in 14 cases (36%), includes 8 patients with mega-esophagus, and LES assessment was not possible. Four cases demonstrated normal LES pressure but demonstrated incomplete relaxation (normotensive achalasia). Dilatation was performed with a 30 mm Rigiflex pneumatic dilator under fluoroscopy at 7psi for 3-30 seconds after loss of waist in 40 patients without complications and excellent symptomatic relief with 3-12 months post procedural weight gain of 7±5 (range: 0-19) kg. Six patients required a second dilatation and another required two further dilatation. The pneumatic dilatations durability during this short study was excellent at 29±11 (range 8-48) months. Similar efficacy and safety profile was noted in patients with mega-esophagus.
    Conclusion: Barium swallow (especially in advanced disease) and manometry (especially in early disease) serve as essential tools for the diagnosis of achalasia and they complement each other. We report two patients presenting with hemetemesis. We obtained excellent results with pneumatic dilatation without any
    complications and this extends to advanced cases of achalasia with mega-esophagus.
    Matched MeSH terms: Esophageal Achalasia
  11. Fulltext Management of a young teenager with recurrent cough and a feeding problem
    Mariana D, Rus Anida A, Hasniah AL, Zaleha AM, Zakaria M, Norzila MZ
    Breathe (Sheff), 2006;3(2):195-198.
    Matched MeSH terms: Esophageal Achalasia
  12. Fulltext Endoscopic pneumatic balloon dilatation for achalasia of the cardia
    Ding PH
    Med J Malaysia, 1995 Dec;50(4):339-45.
    PMID: 8668054
    This study evaluated the efficacy and safety of endoscopic pneumatic balloon dilatation as the initial treatment for achalasia of the cardia. 15 patients with achalasia underwent a total of 19 dilatations using the new polyethylene dilator (Microvasive Rigiflex Balloon Dilator) over the last 6 years. An overall treatment success rate of 93% was achieved. 11 patients (73.3%) have not required a further dilatation and 3 patients (20%) required between 1 and 2 further dilatations. Elective surgery was necessary in 1 patient. The mean follow-up period was 31.5 months. There was no complication or death attributable to the procedure. Endoscopic pneumatic balloon dilation is a safe and effective treatment for achalasia and should be considered as the initial treatment of choice in most patients with achalasia.
    Matched MeSH terms: Esophageal Achalasia/therapy*
  13. Fulltext Anterior dor or posterior toupet with Heller myotomy for achalasia cardia: a systematic review and meta-analysis
    Siddaiah-Subramanya M, Yunus RM, Khan S, Memon B, Memon MA
    World J Surg, 2019 06;43(6):1563-1570.
    PMID: 30756164 DOI: 10.1007/s00268-019-04945-9
    BACKGROUND AND AIMS: Partial fundoplication is commonly performed in conjunction with Heller Myotomy. It is, however, controversial whether anterior Dor or posterior Toupet partial fundoplication is the antireflux procedure of choice. The aim was to perform a systematic review and meta-analysis of studies comparing these two procedures.

    MATERIAL AND METHODS: A search of PubMed, Cochrane database, Medline, Embase, Science Citation Index, Google scholar and current contents for English language articles comparing Dor and Toupet fundoplication following HM between 1991 and 2018 was performed. The outcome variables analyzed included operating time, length of hospital stay (LOHS), overall complication rate, quality of life (QOL), postoperative reflux, residual postoperative dysphagia, treatment failure and reoperations. The meta-analysis was prepared in accordance with the PRISMA-P statement.

    RESULTS: Seven studies totaling 486 patients (Dor = 245, Toupet = 241) were analyzed. LOHS was significantly shorter for Toupet repair compared to Dor procedure (WMD 0.73, 95% CI 0.47 to 0.99; P 
    Matched MeSH terms: Esophageal Achalasia/surgery*
  14. Systematic review and meta-analysis of perioperative outcomes of peroral endoscopic myotomy (POEM) and laparoscopic Heller myotomy (LHM) for achalasia
    Awaiz A, Yunus RM, Khan S, Memon B, Memon MA
    Surg Laparosc Endosc Percutan Tech, 2017 Jun;27(3):123-131.
    PMID: 28472017 DOI: 10.1097/SLE.0000000000000402
    AIMS AND OBJECTIVES: Laparoscopic Heller myotomy (LHM) is the preferred surgical method for treating achalasia. However, peroral endoscopic myotomy (POEM) is providing good short-term results. The objective of this systematic review and meta-analysis was to compare the safety and efficacy of LHM and POEM.

    MATERIALS AND METHODS: A search of PubMed, Cochrane database, Medline, Embase, Science Citation Index, and current contents for English-language articles comparing LHM and POEM between 2007 and 2016 was performed. Variables analyzed included prior endoscopic treatment, prior medical treatment, prior Heller myotomy, operative time, overall complications rate, postoperative gastroesophageal reflux disease (GERD), length of hospital stay, postoperative pain score, and long-term GERD.

    RESULTS: Seven trials consisting of 483 (LHM=250, POEM=233) patients were analyzed. Preoperative variables, for example, prior endoscopic treatment [odds ratio (OR), 1.32; 95% confidence interval (CI), 0.23-4.61; P=0.96], prior medical treatment [weighted mean difference (WMD), 1.22; 95% CI, 0.52-2.88; P=0.65], and prior Heller myotomy (WMD, 0.47; 95% CI, 0.13-1.67; P=0.25) were comparable. Operative time was 26.28 minutes, nonsignificantly longer for LHM (WMD, 26.28; 95% CI, -11.20 to 63.70; P=0.17). There was a comparable overall complication rate (OR, 1.25; 95% CI, 0.56-2.77; P=0.59), postoperative GERD rate (OR, 1.27; 95% CI, 0.70-2.30; P=0.44), length of hospital stay (WMD, 0.30; 95% CI, -0.24 to 0.85; P=0.28), postoperative pain score (WMD, -0.26; 95% CI, -1.58 to 1.06; P=0.70), and long-term GERD (WMD, 1.06; 95% CI, 0.27-4.1; P=0.08) for both procedures. There was a significantly higher short-term clinical treatment failure rate for LHM (OR, 9.82; 95% CI, 2.06-46.80; P<0.01).

    CONCLUSIONS: POEM compares favorably to LHM for achalasia treatment in short-term perioperative outcomes. However, there was a significantly higher clinical treatment failure rate for LHM on short-term postoperative follow-up. Presently long-term postoperative follow-up data for POEM beyond 1 year are unavailable and eagerly awaited.
    Matched MeSH terms: Esophageal Achalasia/surgery*
  15. Fulltext Repair of thoracic oesophageal perforation with latissimus dorsi flap
    Yap CM
    Med J Malaysia, 1994 Mar;49(1):100-1.
    PMID: 8057981
    Thoracic oesophageal perforation, a life-threatening condition, is a therapeutic challenge. A 20 year old male developed a lower oesophageal perforation following an abdominal cardiomyotomy for achalasia of the lower oesophagus. The resulting suppurative mediastinitis and left empyema thoracis were treated by decortication. The oesophageal perforation was closed using a transposition pedicle left latissimus dorsi muscle flap.
    Matched MeSH terms: Esophageal Achalasia/surgery*
  16. Fulltext Transient unilateral parotid gland swelling following upper endoscopy
    Chieng Jin Yu, Then Ru Fah, Sharifah Intan Safura Shahabudin, Pan Yan
    Journal of Clinical and Health Sciences, 2021;6(1):50-52.
    MyJurnal
    Transient parotid gland swelling could happen as complication after per oral endoscopy or
    intubation. We reported a 53-year-old man who developed transient unilateral parotid gland
    swelling following esophagogastroduodenoscopy (OGDS) with dilatation of achalasia cardia.
    The swelling of the parotid gland was transient and resolved completely without any
    intervention.
    Matched MeSH terms: Esophageal Achalasia
  17. Fulltext Laparoscopic Heller myotomy and anterior Dor fundoplication for achalasia cardia in Malaysia: Clinical outcomes and satisfaction from four tertiary centers
    Siow SL, Mahendran HA, Najmi WD, Lim SY, Hashimah AR, Voon K, et al.
    Asian J Surg, 2021 Jan;44(1):158-163.
    PMID: 32423838 DOI: 10.1016/j.asjsur.2020.04.007
    BACKGROUND: To evaluate the clinical outcomes and satisfaction of patients following laparoscopic Heller myotomy for achalasia cardia in four tertiary centers.

    METHODS: Fifty-five patients with achalasia cardia who underwent laparoscopic Heller myotomy between 2010 and 2019 were enrolled. The adverse events and clinical outcomes were analyzed. Overall patient satisfaction was also reviewed.

    RESULTS: The mean operative time was 144.1 ± 38.33 min with no conversions to open surgery in this series. Intraoperative adverse events occurred in 7 (12.7%) patients including oesophageal mucosal perforation (n = 4), superficial liver injury (n = 1), minor bleeding from gastro-oesophageal fat pad (n = 1) & aspiration during induction requiring bronchoscopy (n = 1). Mean time to normal diet intake was 3.2 ± 2.20 days. Mean postoperative stay was 4.9 ± 4.30 days and majority of patients (n = 46; 83.6%) returned to normal daily activities within 2 weeks after surgery. The mean follow-up duration was 18.8 ± 13.56 months. Overall, clinical success (Eckardt ≤ 3) was achieved in all 55 (100%) patients, with significant improvements observed in all elements of the Eckardt score. Thirty-seven (67.3%) patients had complete resolution of dysphagia while the remaining 18 (32.7%) patients had some occasional dysphagia that was tolerable and did not require re-intervention. Nevertheless, all patients reported either very satisfied or satisfied and would recommend the procedure to another person.

    CONCLUSIONS: Laparoscopic Heller myotomy and anterior Dor is both safe and effective as a definitive treatment for treating achalasia cardia. It does have a low rate of oesophageal perforation but overall has a high degree of patient satisfaction with minimal complications.

    Matched MeSH terms: Esophageal Achalasia/complications; Esophageal Achalasia/psychology; Esophageal Achalasia/surgery*
  18. Fulltext Megaoesophagus secondary to oesophagitis and oesophageal stricture associated with doxycycline therapy in a domestic shorthair kitten
    Namira, N.E., Khor, K.H., M. Watanabe, Lim, M.Y.
    Jurnal Veterinar Malaysia, 2015;27(2):5-7.
    MyJurnal
    Oesophageal strictures associated with doxycycline therapy in cats are a rare occurrence but several cases have been reported. A 3-month-old kitten was presented to University Veterinary Hospital, Universiti Putra Malaysia (UVH-UPM) with the primary complaint of persistent vomiting. The kitten was prescribed with doxycycline two weeks prior to presentation. Regurgitation was observed during hospitalisation. Radiographs and endoscopy performed revealed findings consistent with a megaesophagus cranial to an oesophageal stricture located at the region of the second thoracic vertebrae.
    Matched MeSH terms: Esophageal Achalasia
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