Long Esophagomyotomy for Esophageal Spasm-Reply

In Reply.— The use of esophagomyotomy in the treatment of atrial ventricular block related to diffuse esophageal spasm was only briefly mentioned in our report; we avoided any emphasis on this treatment because the previous results 1,2 were unsatisfactory. On the other hand, the long esophagomyotomy performed by Snow and Horrigan in a patient with diffuse spasm seems to have been a complete success. Unfortunately, this result was not available in the literature at the time of publication of our report. We completely agree with these authors that this therapeutic modality is justified from the physiopathological point of view to prevent this anomalous esophagocardiac reflex in patients with diffuse esophageal spasm. However, the decision to perform an esophagomyotomy from the aortic arch to the gastroesophageal junction should be carefully evaluated case by case, together with other therapeutic approaches (eg, anticholinergic administration or pacemaker implantation). In fact, the choice should be