Endoscopic treatment of esophageal achalasia

Abstract

Achalasia is a rare esophageal motility disorder defined by an impairment of lower esophageal sphincter (LES) relaxation and the absence of normal propagated esophageal contraction. The diagnosis is based on manometry and 3 manometric profiles are identified according to the Chicago classification. Medical treatments consist of relaxing LES drugs. Their efficiency is low and side effects limit their utilization. Surgical treatment consists in extra-mucosal Heller myotomy. Cardial pneumatic dilation has similar short and long-term outcomes compared to surgical myotomy with the caveat of repeated pneumatic dilations if necessary. The results of per-oral endoscopic myotomy (POEM) are promising and the morbidity is very low. Recently, some authors have reported successful results of POEM after failure of other treatments including surgery.