European Journal of Cardio-Thoracic Surgery, Vol 10, 634-640, Copyright © 1996 by European Association for Cardio-thoracic Surgery
The relevance of abnormal motility patterns in intra-mural oesophageal leiomyomata
KM Amer, HR Payne and K Jeyasingham
Department of Thoracic Surgery, Frenchay Hospital, Bristol, UK.
OBJECTIVE: Abnormal oesophageal motility patterns of the obstructive type
in patients with gastro-oesophageal reflux without clinical evidence of
obstruction raise the possibility of some co-existing problem. METHODS: In
order to elucidate the relevance of such motility we studied two patients
who were diagnosed as manifesting gastro- oesophageal reflux without
herniation on full oesophageal investigations including radiology,
ambulatory pH metry and endoscopy. In both patients leiomyomata were
enucleated from the gastro- oesophageal junction at the time of surgery for
reflux and subsequent oesophageal motility studies showed a return to near
normal patterns. We studied, in retrospect, the motility patterns of two
other patients with dysphagia due to a leiomyoma in the middle and upper
oesophagus, respectively, and in whom the diagnosis of an oesophageal
leiomyoma was made on clinical and radiological criteria. One of these
patients was also studied post-operatively. RESULTS: A detailed study of
these motility patterns shows exaggerated oesophageal contractions without
features specific to achalasia cardia or localised oesophageal spasm, and
that these features are reversed by surgical enucleation of the tumour.
CONCLUSIONS: In these four patients the abnormal motilities are
attributable to the presence of the intramural tumours despite the absence
of clinical evidence of obstruction.
