Peroral Endoscopic Myotomy for Treating Achalasia and Esophageal Motility Disorders

Youn, Young Hoon; Minami, Hitomi; Chiu, Philip Wai Yan; Park, Hyojin

doi:10.5056/jnm15191

Cited by 56 publications

(36 citation statements)

References 66 publications

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“…In achalasia, the LES may be hypertensive and show impaired relaxation in response to swallowing. 3 In GERD, the LES can either be hypotensive or display frequent relaxations. Therefore, LES dysfunction in achalasia may serve as a substantial barrier to the reflux of gastric contents, and GERD may not be expected to appear frequently in patients with achalasia.…”

Section: Introductionmentioning

confidence: 99%

Is Gastroesophageal Reflux Disease and Achalasia Coincident or Not?

Jung

Park

2017

J Neurogastroenterol Motil

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Achalasia and gastroesophageal reflux disease (GERD) are on opposite ends of the spectrum of lower esophageal sphincter dysfunction. Heartburn is the main symptom of GERD. However, heartburn and regurgitation are frequently observed in patients who have achalasia. The diagnosis of achalasia might be delayed because these symptoms are misinterpreted as gastroesophageal reflux. Here, we reviewed the clinical characteristics of patients with the erroneous diagnosis of GERD who actually had untreated achalasia.

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Section: Introductionmentioning

confidence: 99%

Is Gastroesophageal Reflux Disease and Achalasia Coincident or Not?

Jung

Park

2017

J Neurogastroenterol Motil

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“…POEM has been used for all types of esophageal motility disorders, including, but not restricted to, advanced sigmoid achalasia and spastic motility disorders of the esophagus [50,51]. POEM has even been performed successfully on refractory cases of achalasia following previous balloon dilation or laparoscopic Heller myotomy [52][53][54][55].…”

Section: Treatmentmentioning

confidence: 99%

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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“…Besides BD, other therapeutic possibilities are developing [27][28][29][30][31][32] but this method will remain the most convenient option for most patients.…”

Section: Discussionmentioning

confidence: 99%

Esophageal two-phase supine/standing scintigraphy and balloon dilatation in achalasia: 20 years of experience

et al. 2021

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Background/Aim. The purpose of this paper is to present the results of esophageal scintigraphy (ES) in achalasia treated by balloon dilatation (BD) for a long period of time between years 1997 and 2016 and to set parameters suitable for prediction of treatment outcomes. Methods. Two-phase ES in anterior projection was performed. The first phase involved swallowing 10 ml of water with 18.5 MBq 99m Tc in supine position. The second phase was performed in standing position after swallowing 100 ml of water. Retention index (RI) of esophageal radioactivity was calculated after the imaging using registered esophageal and gastric counts. ES was performed in 52 patients (34 male and 18 female, aged 22-75 years, median patient age of 44 years) before and after BD. In 32 patients only two scintigraphies were performed. In remaining 20 patients follow-up and repeated scintigraphies were continued including the patients with therapeutic failure and repeated BD. BD was repeated in 8 patients and those were followed up and evaluated over time.Modified BD was performed with Rigiflex balloon dilators. Results. Typical scintigraphic finding in supine position was passive esophageal filling without evidence of motility and in most of patients (43) absent radionuclide elimination to stomach (83%). Evaluating values before and longer after the first BD it has been shown that certain values of RI indicate remission or relapse of disease. The RI difference more than 50% after BD was a reliable indicator of longer remission The age and gender of patients had no impact on dilatation outcome but younger patients were with higher risk of early failure (6 patients during first year after BD). ES showed that the first BD was successful initially in 50 patients and after follow-up in 42 patients (81%). Conclusion. Two-phase supine/standing esophageal scintigraphy is most suitable for diagnosing and follow-up of achalasia.Retention index represents an important parameter for evaluation and prediction of therapeutic response. The RI difference more than 50% after BD is a reliable predictor of longer remission. Age and gender have no impact on dilatation outcome but patients younger than 40 years are with higher risk of early therapeutic failure.

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Peroral Endoscopic Myotomy for Treating Achalasia and Esophageal Motility Disorders

Cited by 56 publications

References 66 publications

Is Gastroesophageal Reflux Disease and Achalasia Coincident or Not?

Is Gastroesophageal Reflux Disease and Achalasia Coincident or Not?

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

Esophageal two-phase supine/standing scintigraphy and balloon dilatation in achalasia: 20 years of experience

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