Endoscopic and Surgical Treatments for Achalasia

Campos, Guilherme M.; Vittinghoff, Eric; Rabl, Charlotte; Takata, Mark; Gadenstätter, Michael; Lin, Feng; Ciovica, Ruxandra

doi:10.1097/sla.0b013e31818e43ab

Cited by 632 publications

(576 citation statements)

References 102 publications

(32 reference statements)

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“…Studies initially showed superiority of surgical myotomy in terms of efficiency and durability compared to single balloon dilatation [35,36]. Further comparison of these two modalities has shown similar outcomes in treatment success rates after 2-year follow-up when a graded approach to PD has been used [32,37,38]. Pneumatic balloon dilatation and surgical myotomy therefore remain the universally accepted treatments for achalasia presently, and patients should be followed up long term [39].…”

Section: Treatmentmentioning

confidence: 99%

“…Surgical LES myotomy also disrupts the LES fibers with a longitudinal incision. The preferred method has been the laparoscopic approach, or laparoscopic Heller myotomy (LHM), due to decreased morbidity and faster recovery [31,32]. Though this method effectively relieves the obstruction, it also increases the risk of gastroesophageal reflux, and most surgeons incorporate an anti-reflux procedure by way of a partial fundoplication [33,34].…”

Section: Treatmentmentioning

confidence: 99%

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Current status of achalasia management: a review on diagnosis and treatment

Tuason

Inoue

2017

J Gastroenterol

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Background Achalasia is a rare esophageal motility disorder that is characterized by loss of peristalsis and failure of relaxation of the lower esophageal sphincter (LES), particularly during swallowing. This review focuses on the diagnosis of esophageal motility disorders as defined by the Chicago Classification ver 3.0, and presents management options with regard to per-oral endoscopic myotomy (POEM) as the treatment of choice. Methods A concise review of literature was performed for articles related to the management of achalasia, and this was contrasted with our institution's current practice. Results Achalasia is still incompletely understood, and management is focused on establishing a proper diagnosis, and relieving the obstructive symptoms. Conclusions Achalasia should be considered when dysphagia is present, and not otherwise caused by an obstruction or inflammation, and when criteria is met as per the Chicago Classification ver 3.0. Lowering LES tone and disruption of LES can be accomplished by various methods, most notably pneumatic balloon dilatation and surgical myotomy. POEM has been gaining momentum as a first line therapy for achalasia symptoms, and can be considered an important tool for motility disorders of the esophagus.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Current status of achalasia management: a review on diagnosis and treatment

Tuason

Inoue

2017

J Gastroenterol

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“…Many studies suggest and reccomend to use a graded dilator approach, given the good to excellent relief of symptoms in 50-93% of the treated patients (42)(43)(44).…”

Section: Pneumatic Dilationmentioning

confidence: 99%

High Resolution Manometry - A Mandatory Examination in the Pre and Postoperative Assessment of Patients with Achalasia

Dimitriu¹,

Gheorghe²

2018

chr

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RezumatManometria esofagiană cu rezoluţie înaltă este actual investigaţia gold-standard în diagnosticul acalaziei şi a bolilor esofagiene funcţionale. Această examinare este întotdeauna precedată de endoscopia digestivă superioară, care are scopul de a face diagnosticul diferenţial al acalaziei cu pseudoacalazia (formaţiuni tumorale de fornix gastric/esofag distal). La momentul actual, nu există tratament curativ pentru acalazie. Însă, cele 3 subtipuri de acalazie (conform clasificării Chicago) au răspuns diferit în ceea ce priveşte eficacitatea în tratamentului ales. Astfel, comparativ cu tipurile I şi III, tipul II de acalazie are cel mai bun răspuns la intervenţiile terapeutice invazive (dilatare pneumatică sau cardiomiotomie Heller). În schimb, în tipul III cardiomiotomia Heller este de ales ca prima abordare terapeutică. Miotomia endoscopică perorală (POEM) este o tehnică relativ recentă, care necesită însă studii pe termen lung în ceea ce priveşte siguranţa şi eficacitatea. Articolul prezent îşi propune să prezinte variantele actuale de tratament ale acalaziei, comparându-le pe baza eficacităţii şi siguranţei pe termen scurt şi lung, subliniind de asemenea rolul manometriei cu rezoluţie înaltă în diagnosticul, alegerea metodei terapeutice şi prognosticul acestor pacienţi. Review ArticleAbstract High resolution manometry (HRM) is currently the gold standard for the diagnosis of achalasia and other functional esophageal disorders. All patients accusing dysphagia should be endoscopically evaluated prior to manometric investigations in order to rule out pseudoachalasia. The Chicago HRM classification has led to a subclassification of three manometric types of achalasia that seem to have different results to treatment. None of the actual achalasia treatment options are curative. Type II achalasia patients respond best to all treatment options compared to those with types I and III. Pneumatic dilation (PD) or Heller miotomy (LHM) can be both chosen as initial therapy in type I and II as they have good outcome , while type III achalasia patients respond better to LHM as a first therapeutic option. Peroral endoscopic myotomy (POEM) is a promising new technique but long-term follow-up studies for its safety and efficacy must be performed. This article reviews the current therapeutic options in achalasia and other functional esophageal disorders, based on the differences in safety and efficacy between approaches, highlighting the impact of HRM to predict the outcome but also the role of the techinque in guiding antireflux surgery.

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“…Laparoscopic Heller myotomy (LHM) improves the symptoms of patients. The reported clinical success rate is 89% (range 76-100%) [9]. The most common post-myotomy complication is gastro-esophageal reflux disease (GERD).…”

mentioning

confidence: 99%

Is Heller Myotomy Better than Balloon Dilation? A Meta-Analysis

Illés

Farkas

Hegyi³

et al. 2017

JGLD

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Background & Aim: Endoscopic balloon dilation (EBD) and laparoscopic Heller myotomy (LHM) are the most commonly performed treatment options for achalasia. Decision between these treatment options is difficult. The aim of this meta-analysis was to evaluate the efficacy of EBD compared to LHM.Methods: The electronic databases PubMed, Embase and Cochrane Controlled Trials Registry were systematically searched for the period between January 1, 1976 and December 31, 2015. Meta-analysis was performed using the PICOS (problem, intervention, comparison, outcome, study design) format. Efficacy and safety of EBD were compared to LHM. Forest plot analyses were used to illustrate the success rate, perforation rate and post-procedural gastroesophageal reflux.Results: Using the search strategy, eight studies met the selection criteria and were included in the meta-analysis. The total number of patients included was 749 (360 in the EBD group and 389 in the LHM group). The success rate was lower in the EBD group than in the LHM group (OR=0.486; CI: 0.304-0.779; p=0.003). The rate of perforation did not differ significantly between the EBD and LHM group (RR= 0.635, CI: 0.340-1.186, p=0.154). The incidence of post-procedural symptomatic gastroesophageal reflux did not differ between the two treatment groups (RR=0.663, CI: 0.328-1.343, p=0.254).Conclusion: Our data suggest that the efficacy of LHM is superior to that of EBD, while there is no difference in safety between the two treatment groups.Abbreviations: EBD: endoscopic balloon dilation; GERD: gastro-esophageal reflux disease; LES: lower esophageal sphincter; LHM: laparascopic Heller myotomy; OR: odds ratio; PICOS: Problem, Intervention, Comparison, Outcome, Study design; POEM: Per Oral Endoscopic Myotomy; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analysis; RR: risk ratio.

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Endoscopic and Surgical Treatments for Achalasia

Abstract: EBD is superior to EBTI. Laparoscopic myotomy with fundoplication was the most effective surgical technique and can be considered the operative procedure of choice.

Cited by 632 publications

References 102 publications

Current status of achalasia management: a review on diagnosis and treatment

Current status of achalasia management: a review on diagnosis and treatment

High Resolution Manometry - A Mandatory Examination in the Pre and Postoperative Assessment of Patients with Achalasia

Is Heller Myotomy Better than Balloon Dilation? A Meta-Analysis

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