Endoscopic management of achalasia

Achalasia is an esophageal motility disorder characterized by impaired LES relaxation and absent peristalsis in the distal esophagus. Note, however, that absent peristalsis means that there is no progressively sequenced esophageal contraction; it does not imply the complete absence of esophageal contractions or intraluminal pressure. In fact, spastic contractions and panesophageal pressurization of the esophagus are often seen in patients with achalasia, and these criteria are now part of the Chicago classification for subtypes of achalasia (Bredenoord AJ, Fox M, Kahrilas PJ et al, Neurogastroenterol Motil:24(Suppl 1):57, 2012). The scope of endoscopic treatment for achalasia has also evolved over the past 5 years with the emergence of per-oral endoscopic myotomy.