Endoscopic Surveillance in Idiopathic Achalasia

Abstract

Idiopathic achalasia is a rare esophageal dysmotility disorder of unknown etiology with only palliative treatment available. Many studies have established a significantly increased risk of esophageal cancer in patients with achalasia. However, current guidelines advise against routine surveillance due to low absolute risk and a paucity of high-quality evidence and cost-effectiveness assessments. This review aims to assess the need for routine endoscopic surveillance in achalasia based on a growing body of literature calling in support of it, mainly due to the increased risk of esophageal cancer. We searched PubMed and Google Scholar electronic databases for articles within the last 10 years using the keywords 'achalasia', 'cancer,' 'neoplasms,' 'screening,' and 'surveillance.' After excluding pseudoachalasia/secondary achalasia, other esophageal dysmotility disorders, and associations with malignancies outside the esophagus, we selected 31 articles for this review. Through these articles, we identified areas of focus for ongoing and future research that may result in significant risk reduction of complications, including esophageal cancer and beyond.

Surveillance Endoscopy After Foregut Surgery: Is It Necessary?

“…The American College of Gastroenterology concurs with the ASGE and they advocate for further investigation into long-term surveillance as prior recommendations were based on studies with smaller follow-up periods (<2 years). 31,41 European guidelines recommend against systematic screening but suggest a low threshold for endoscopy in recurrent symptoms and longstanding achalasia. 42 A literature review of endoscopic surveillance following POEM or LHM is demonstrated in Table 2.…”

Laparoscopic Heller’s cardiomyotomy for achalasia cardia-a case series with review of literature

“…Calcium channel blockers, nitrates, and PPIs are commonly used to control acid reflux; however, they provide only short-term relief and are less effective. 17 Traditional endoscopic treatment of achalasia involves injections of botulinum toxin type A (Botox) and pneumatic dilation (PD). Botox is a biological neurotoxin released by Clostridium botulinum that can prevent the release of acetylcholine from voluntary and involuntary muscle nerve endings.…”