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Peritoneoscopy and direct-vision liver biopsy are simple, safe, and accurate methods for the documentation of focal lesions predominantly involving the left lobe of the liver or the left portion of the right lobe. Focal lesions of the left lobe of the liver constitute a major indication for peritoneoscopy and direct-vision biopsy of the liver when its use is not contraindicated and when blind percutaneous biopsy or biopsies and cytologic examination have failed to establish the diagnosis.

Botox injection and pneumatic dilation are common therapies for achalasia. We sought to determine the impact of these preoperative therapies on esophageal muscle histology and outcomes after laparoscopic Heller myotomy. A total of 73 consecutive patients had esophageal muscle biopsies taken from the gastroesophageal junction at the time of myotomy between November 1998 and November 2001. Muscle fibrosis was graded by a senior pathologist who was blinded to preoperative treatments and postoperative outcomes. Patients graded their dysphagia and heartburn symptoms before and after myotomy and graded their outcomes at follow-up. Patients were grouped according to the preoperative endoscopic treatment (dilation, Botox, both, or neither) and the groups were compared. Preoperative therapy did not correlate with esophageal fibrosis or postoperative outcomes, and the degree of esophageal muscle fibrosis was not predictive of outcome. Symptom scores improved significantly for dysphagia (4.5 ± 0.9 vs. 1.6 ± 1.6) and heartburn (2.3 ± 1.8 vs. 1.5 ± 1.4) irrespective of preoperative therapy or fibrosis. Overall, excellent or good outcomes were obtained in 92% of patients at follow-up of 15.7 months ± 14.4. Successful outcomes are highly probable after laparoscopic Heller myotomy regardless of preoperative interventions. The amount of fibrosis in the esophageal muscle is not related to preoperative intervention and is not predictive of outcomes. (J Gastrointest Surg 2003;7:181–190.) [Copyright &y& Elsevier]