scholarly journals Endoscopic approaches to treatment of achalasia

2012 ◽  
Vol 6 (2) ◽  
pp. 115-135 ◽  
Author(s):  
Stavros N. Stavropoulos ◽  
David Friedel ◽  
Rani Modayil ◽  
Shahzad Iqbal ◽  
James H. Grendell
Keyword(s):  
Botulinum Toxin Injection ◽  
Balloon Dilation ◽  
Pneumatic Dilation ◽  
Endoscopic Stent ◽  
Extensive Training ◽  
Treatment Paradigm ◽  
Endoscopic Myotomy ◽  
Large Balloon ◽  
Esophageal Sphincter ◽  
Per Oral

Endoscopic therapy for achalasia is directed at disrupting or weakening the lower esophageal sphincter (LES). The two most commonly utilized endoscopic interventions are large balloon pneumatic dilation (PD) and botulinum toxin injection (BTI). These interventions have been extensively scrutinized and compared with each other as well as with surgical disruption (myotomy) of the LES. PD is generally more effective in improving dysphagia in achalasia than BTI, with the latter reserved for infirm older people, and PD may approach treatment results attained with myotomy. However, PD may need to be repeated. Small balloon dilation and endoscopic stent placement for achalasia have only been used in select centers. Per oral endoscopic myotomy is a newer endoscopic modality that will likely change the treatment paradigm for achalasia. It arose from the field of natural orifice transluminal endoscopic surgery and represents a scarless endoscopic approach to Heller myotomy. This is a technique that requires extensive training and preparation and thus there should be rigorous accreditation and monitoring of outcomes to ensure safety and efficacy.

If pneumatic dilation is not enough efficient for post fundoplication dysphagia, is Per Oral Endoscopic Myotomy a good answer to manage it?

Gut ◽  
2021 ◽  
pp. gutjnl-2021-324238
Author(s):  
Antoine Debourdeau ◽  
Véronique Vitton ◽  
Marc A Barthet ◽  
Jean-Michel Gonzalez
Keyword(s):  
Pneumatic Dilation ◽  
Per Oral Endoscopic Myotomy ◽  
Endoscopic Myotomy ◽  
Per Oral

Sp846 Per-Oral Endoscopic Myotomy for Treatment of Hypertensive Lower Esophageal Sphincter

2011 ◽  
Vol 73 (4) ◽  
pp. AB107 ◽  
Author(s):  
Philip W.Y. Chiu ◽  
Haruhiro Inoue ◽  
Anthony Y.B. Teoh ◽  
Simon K.H. Wong ◽  
Enders K.W. Ng
Keyword(s):  
Lower Esophageal Sphincter ◽  
Hypertensive Lower Esophageal Sphincter ◽  
Per Oral Endoscopic Myotomy ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter ◽  
Per Oral

Outcomes of Peroral Endoscopic Myotomy After Previously Failed Botulinum Toxin Injection and/or Pneumatic Dilation

2017 ◽  
Vol 112 ◽  
pp. S453
Author(s):  
Sarah Z. Maher ◽  
Jayakrishna Chintanaboina ◽  
Eric Pauli ◽  
Jennifer L. Maranki ◽  
Abraham Mathew
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin Injection ◽  
Peroral Endoscopic Myotomy ◽  
Pneumatic Dilation ◽  
Endoscopic Myotomy

scholarly journals Advances in the diagnosis and treatment of achalasia of the cardia: A review

2021 ◽  
Vol 9 (1) ◽  
pp. 24-31
Author(s):  
Baozhen Zhang ◽  
Yidan Wang ◽  
Ye Liao ◽  
Jingjing Zhang ◽  
Yufan Wu ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Peroral Endoscopic Myotomy ◽  
Diagnosis And Treatment ◽  
Pneumatic Dilation ◽  
Motor Disorder ◽  
Sphincter Pressure ◽  
Idiopathic Achalasia ◽  
Retrosternal Pain ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter

Abstract Idiopathic achalasia is an esophageal motor disorder characterized by the loss of the lower esophageal sphincter ganglion, resulting in impaired lower esophageal relaxation and absence of esophageal peristalsis. Patients commonly present with progressive dysphagia accompanied by reflux, heartburn, retrosternal pain, and severe weight loss. Diagnosis is primarily based on the patient’s chief complaints, barium esophagography, and the most recent high-resolution manometry. Endoscopic assessment and endoscopic ultrasonography also have significant value with regard to the exclusion of esophageal anatomical lesions, neoplastic diseases, and pseudoachalasia. However, as most patients with achalasia demonstrate a gradual onset, early diagnosis is difficult. Currently, treatment of idiopathic achalasia, including pneumatic dilation, stent placement, and surgical myotomy, is aimed at reducing lower esophageal sphincter pressure and relieving the symptoms of dysphagia. Peroral endoscopic myotomy has gradually become the mainstream treatment because it causes less trauma and has a rapid recovery rate. This article reviews the main methods of diagnosis and treatment of achalasia, with an emphasis on the potential of peroral endoscopic myotomy and the advancements of immunotherapy for achalasia.

scholarly journals Sa1256 A COST-EFFECTIVENESS ANALAYSIS OF TREATMENT OPTIONS FOR ACHALASIA: PNEUMATIC DILATION VS HELLER MYOTOMY VS PER-ORAL ENDOSCOPIC MYOTOMY

2020 ◽  
Vol 91 (6) ◽  
pp. AB134-AB135
Author(s):  
Thomas R. McCarty ◽  
Pichamol Jirapinyo ◽  
Lyndon James ◽  
Walter W. Chan ◽  
Christopher C. Thompson
Keyword(s):  
Cost Effectiveness ◽  
Heller Myotomy ◽  
Treatment Options ◽  
Pneumatic Dilation ◽  
Per Oral Endoscopic Myotomy ◽  
Endoscopic Myotomy ◽  
Per Oral

Type II achalasia is associated with a comparably favorable outcome following per oral endoscopic myotomy

2020 ◽  
Author(s):  
Yutaka Tomizawa ◽  
Nadim Mahmud ◽  
Kevin Dasher ◽  
Joseph R Triggs ◽  
Monica Saumoy ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Clinical Success ◽  
Botulinum Toxin Injection ◽  
Motility Disorder ◽  
Favorable Outcome ◽  
Type Ii ◽  
Esophageal Motility Disorder ◽  
Treatment Naïve ◽  
Endoscopic Myotomy ◽  
Per Oral

Summary Per oral endoscopic myotomy (POEM) is a safe and effective treatment for esophageal motility disorder in treatment-naïve patients as well as salvage therapy. Though type II achalasia, compared to other subtypes, is reported to have a more favorable outcome with pneumatic dilation (PD) or Heller myotomy (HM), it is unclear whether achalasia subtype predicts symptom response to POEM. We aimed to evaluate whether type II achalasia is associated with a comparably favorable outcome following POEM. We performed a retrospective review of patients with esophageal motility disorder who were referred for POEM from April 2014 to June 2017. The main outcome was clinical success based on Eckardt score ≤3 and its association with subtype and safety. A total of 63 patients (mean age 51 years [SD 15]; 63% male) underwent a total of 68 POEMs with median of 263 days follow-up. Of these, 45 (71.3%) patients were type II achalasia. In all, 29 (46%) patients were treatment-naïve and 34 (54%) patients had previous endoscopic or surgical therapy including botulinum toxin injection in 16 (25%), PD in 10 (16%), both botulinum toxin injection and PD in 8 (13%) and HM in 3 (5%). Technical success was 100% and clinical success was achieved in 51 (81%) patients. The rate of clinical success was higher in patients with type II achalasia compared to the other subtypes (88.9% vs. 61.1% [P = 0.028]) and type II achalasia patients required fewer redo POEM (2.2% vs. 22.2% [P = 0.021]). Multivariate logistic regression analysis demonstrated the positive prediction of clinical success for type II achalasia following POEM (P = 0.046). As observed with PD and HM, type II achalasia was associated with a favorable clinical outcome following POEM.

Outcomes of peroral endoscopic myotomy in patients with achalasia and prior bariatric surgery: A multicenter experience

2021 ◽  
Author(s):  
S Bomman ◽  
J S Klair ◽  
M Ashat ◽  
R El Abiad ◽  
H Gerke ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Clinical Success ◽  
Botulinum Toxin Injection ◽  
Clinical Success Rate ◽  
Peroral Endoscopic Myotomy ◽  
Pneumatic Dilation ◽  
Type I ◽  
Eckardt Score ◽  
Endoscopic Myotomy ◽  
The Mean

Summary Peroral endoscopic myotomy (POEM) in patients with achalasia who are status post bariatric surgery may be technically challenging due to postsurgical scarring and altered anatomy. The aim of the study was to assess the efficacy and safety of POEM for achalasia in patients with prior bariatric surgery. A review of prospectively maintained databases at three tertiary referral centers from January 2015 to January 2021 was performed. The primary outcome of interest was clinical success, defined as a post-treatment Eckardt score ≤ 3 or improvement in Eckardt score by ≥ 1 when the baseline score was <3, and improvement of symptoms. Secondary outcomes were adverse event rates and symptom recurrence. Sixteen patients status post Roux-en-Y gastric bypass (n = 14) and sleeve gastrectomy (n = 2) met inclusion criteria. Indications for POEM were achalasia type I (n = 2), type II (n = 9), and type III (n = 5). POEM was performed either by anterior or posterior approach. The pre-POEM mean integrated relaxation pressure was 26.2 ± 7.6 mm Hg. The mean total myotomy length was 10.2 ± 2.7 cm. The mean length of hospitalization was 1.4 ± 0.7 days. Pre- and postprocedure Eckardt scores were 6.1 ± 2.1 and 1.7 ± 1.8, respectively. The overall clinical success rate was 93.8% (15/16) with mean follow-up duration of 15.5 months. One patient had esophageal leak on postprocedure esophagram and managed endoscopically. Dysphagia recurred in two patients, which was successfully managed with pneumatic dilation with or without botulinum toxin injection. POEM appears to be safe and effective in the management of patients with achalasia who have undergone prior bariatric surgery.

scholarly journals Achalasia: current therapeutic options

2017 ◽  
Vol 8 (6-7) ◽  
pp. 101-108 ◽  
Author(s):  
Zubin Arora ◽  
Prashanthi N. Thota ◽  
Madhusudhan R. Sanaka
Keyword(s):  
Esophageal Motility ◽  
Heller Myotomy ◽  
Symptomatic Relief ◽  
Treatment Options ◽  
Motility Disorder ◽  
Pneumatic Dilation ◽  
Esophageal Peristalsis ◽  
Esophageal Motility Disorder ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter

Achalasia is a chronic incurable esophageal motility disorder characterized by impaired lower esophageal sphincter (LES) relaxation and loss of esophageal peristalsis. Although rare, it is currently the most common primary esophageal motility disorder, with an annual incidence of around 1.6 per 100,000 persons and prevalence of around 10.8/100,000 persons. Symptoms of achalasia include dysphagia to both solids and liquids, regurgitation, aspiration, chest pain and weight loss. As the underlying etiology of achalasia remains unclear, there is currently no curative treatment for achalasia. Management of achalasia mainly involves improving the esophageal outflow in order to provide symptomatic relief to patients. The most effective treatment options for achalasia include pneumatic dilation, Heller myotomy and peroral endoscopic myotomy (POEM), with the latter increasingly emerging as the treatment of choice for many patients. This review focusses on evidence for current and emerging treatment options for achalasia with a particular emphasis on POEM.

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