A Successfully Effective Case Receiving Laparoscopic Esophagogastroplasty Against CREST Syndrome Complicated with Reflux Esophagitis

Abstract

We experienced a case of CREST syndrome complicated by reflex esophagitis of which the main complaint was dysphagia. In the roentgenographic examination of the upper digestive tract, the esophagus was dilated like achalasia and the lower part of the esophagus was narrowed. According to the classification of achalasia, the case was rated as Flask type of grade III. In the endoscopic examination, about 5 cm confluently circular the esophagitis rated as grade III of the Savary & Miller classification was observed. In the 24-hour continuous pH monitoring, gastroesophageal acid reflux was observed corresponding to only the postprandial period. The time spent lower than 4.0pH units was 9.8%, which was significantly prolonged. In order to relieve the difficulty of esophageal passage and to improve the function of preventing reflux, a laparoscopic Heller-Dor operation was conducted. After the operation symptoms including the main complaint of dysphagia disappeared and the narrowed esophagus was relieved. The esophagitis was ameliorated to a trace. The time spent lower than 4.0pH units was 0%. These results suggested that the present operation was effective as a surgical approach against symptoms accompanying the esophageal dysfunction of scleroderma.