AIM:Modified Heller’s myotomy is still the first choice forachalasia and the assessment of surgical outcomes is usuallymade based on the subjective sensation of patients.Thisstudy was to objectively assess the long-term outcomes ofesophageal myotomy for achalasia using esophagealmanometry,24-hour pH monitoring,esophageal scintigraphyand fiberoptic esophagoscopy.METHODS:From February 1979 to October 2000,176patients with achalasia underwent modified Heller’smyotomy,including esophageal myotomy alone in 146patients,myotomy in combination with Gallone or Dorantireflux procedure in 22 and 8 patients,respectively.Clinicalscore,pressure of the lower esophageal sphincter (LES),esophageal clearance rate and gastroesophageal reflux weredetermined before and 1 to 22 years after surgery.RESULTS:After a median follow-up of 14 years,84.5% ofpatients had a good or excellent relief of symptoms,andclinical scores as well as resting pressures of the esophagealbody and LES were reduced compared with preoperativevalues (P<0.001).However,there was no significant differencein DeMeester score between pre- and postoperative patients(P=0.51).Esophageal transit was improved in postoperativepatients,but still slower than that in normal controls.Theincidence of gastroesophageal reflux in patients whounderwent esophageal myotomy alone was 63.6% comparedto 27.3% in those who underwent myotomy and antirefluxprocedure (P=0.087).Three (1.7%) patients were complicatedwith esophageal cancer after surgery.CONCLUSION:Esophageal myotomy for achalasia canreduce the resting pressures of the esophageal body andLES and improve esophageal transit and dysphagia.Myotomyin combination with antireflux procedure can preventgastroesophageal reflux to a certain extent,but furtherrandomized studies should be carried out to demonstrateits efficacy. AIM: Modified Heller’s myotomy is still the first choice forachalasia and the assessment of surgical outcomes is usually made based on the subjective sensation of patients. This study was to objectively assess the long-term outcomes of esophageal myotomy for achalasia using esophagealmanometry, 24-hour pH monitoring, esophageal scintigraphy and fiberoptic esophagoscopy. METHODS: From February 1979 to October 2000,176 patients with achalasia underwent modified Heller’s myotomy, including esophageal myotomy alone in 146patients, myotomy in combination with Gallone or Dorantireflux procedure in 22 and 8 patients, respectively. Clinical scale, pressure of the lower esophageal sphincter (LES), esophageal clearance rate and gastroesophageal reflux were confirmed before and 1 to 22 years after surgery. RESULTS: After a median follow-up of 14 years, 84.5% of patients had a good or excellent relief of symptoms, and clinical qualities as well as resting pressures of the esophagealbody and LES were reduced compared with pre There was no significant difference in DeMeester score between pre- and postoperative patients (P = 0.51). Esophageal transit was improved in postoperative patients, but still slower than that in normal controls.The incidence of gastroesophageal reflux in patients whounderwent esophageal myotomy alone was 63.6% comparedto 27.3% in those who underwent myotomy and antirefluxprocedure (P = 0.087). Three (1.7%) patients were complicatedwith esophageal cancer after surgery. CONCLUSION: Esophageal myotomy for achalasia canreduce the resting pressures of the esophageal body andLES and improve esophageal transit and dysphagia. Myotomyin combination with antireflux procedure can preventgastroesophageal reflux to a certain extent, but furtherrandomized studies should be carried out to demonstrateits efficacy.