Treatment and surveillance strategies in achalasia: an update

Abstract

Controversy exists with regard to the optimal treatment for achalasia and whether surveillance for early recognition of late complications is indicated. Currently, surgical myotomy and pneumatic dilation are the most effective treatments for patients with idiopathic achalasia, and a multicenter, randomized, international trial has confirmed similar efficacy of these treatments, at least in the short term. Clinical predictors of outcome, patient preferences and local expertise should be considered when making a decision on the most appropriate treatment option. Owing to a lack of long-term benefit, endoscopic botulinum toxin injection and medical therapies are reserved for patients of advanced age and those with clinically significant comorbidites. The value of new endoscopic, radiologic or surgical treatments, such as peroral endoscopic myotomy, esophageal stenting and robotic-assisted myotomy has not been fully established. Finally, long-term follow-up data in patients with achalasia support the notion that surveillance strategies might be beneficial after a disease duration of more than 10-15 years.

Peroral endoscopic myotomy for advanced achalasia with sigmoid-shaped esophagus: long-term outcomes from a prospective, single-center study

“…These symptoms are primarily caused by incomplete relaxation of a frequently hypertensive lower esophageal sphincter (LES) and to some extent by a lack of peristalsis in the tubular esophagus [1]. Unfortunately, no therapy returns normal esophageal function.…”

Miotomía esofágica endoscópica peroral para el tratamiento de la acalasia

“…1). 12 . La eficacia fue uniformemente excelente (90-100% a los 3-12 meses), excepto en la serie del estudio multicéntrico europeo, donde fue del 82% en los pacientes que completaron un año de seguimiento 13 .…”

Per Oral Endoscopic Myotomy in Children with Achalasia Cardia

“…Pre-operative symptom evaluation was done using Eckardt score. 8 HRM was performed with a 16 channel water perfused catheter (Dent sleeve International Limited, manufactured by Mui Scientific, Ontario, Canada). The data were analyzed using Trace 1.2 V software (Geoff Hebbard, Royal Melbourne Hospital, Victoria, Australia).…”