Oesophagectomy in End-Stage Achalasia.

Presentation A 53 year old male with known Chicago Classification type II achalasia, and successful pneumatic dilatation five years previously, presented with severe dysphagia and 17.5 kg weight loss over 3 months. Diagnosis He underwent OGD and contrast imaging to reveal a mega oesophagus secondary to progressive achalasia. Treatment After initial nutritional pre-habilitation with naso-enteric feeding, he underwent a laparoscopic heller's myotomy with clinical and radiological improvement. However quick relapse of symptoms and a failed, atonic, massively dilated oesophagus lead to the decision to proceed to transhiatal oesophagectomy. Discussion Achalasia is a spectrum of motility disorder, and where it has progressed to mega-oesophagus, the success of standard therapeutic approaches is limited. End stage achalasia in this context, with nutritional failure or recurrent pneumonia/bronchiectasis, can be safely treated with an oesophageal resection which is curative, removing a "failed" oesophagus in its entirety.