Abstract
Achalasia is a rare esophageal motility disorder that necessitates the disruption of the lower esophageal sphincter. Patients with achalasia should be evaluated in a systematic, multidisciplinary fashion. Workup should include upper endoscopy, esophagography, and high-resolution manometry. The gold standard for surgical treatment is laparoscopic Heller myotomy with partial fundoplication. Per-oral esophageal myotomy is a novel endoscopic technique that has gained considerable traction over the past decade. The procedure includes the creation of a submucosal tunnel and a selective circular myotomy of the lower esophageal sphincter. Common intra-operative hazards include bleeding within the submucosal tunnel and capnoperitoneum. Significant complications are rare. Patients experience excellent dysphagia relief that is on par with laparoscopic Heller myotomy at moderate-term follow up. Post-operative gastroesophageal reflux disease occurs in greater than one-third of patients, and the vast majority of cases are readily controlled with an anti-secretory medication. Although data is sparse, there is a growing body of literature that supports the long-term durability of per-oral esophageal myotomy.
Original language | English (US) |
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Pages (from-to) | 114-119 |
Number of pages | 6 |
Journal | Techniques in Gastrointestinal Endoscopy |
Volume | 20 |
Issue number | 3 |
DOIs | |
State | Published - Jul 2018 |
Keywords
- Abbreviations: POEM, Per-Oral Esophageal Myotomy
- DI, Distensibility Index
- EGD, Esophagogastroduodenoscopy
- EGJ, Esophagogastric Junction
- ESD, Endoscopic Submucosal Dissection
- Endoscopic submucosal dissection
- Endoscopic surgery
- Esophagus
- Foregut surgery
- GERD, Gastroesophageal Reflux Disease
- HRIM, High-Resolution Impedance Manometry
- HRM, High-Resolution Manometry
- Motility
- NPO, Nil Per Os
- TBE, Time Barium Esophagram
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
- Gastroenterology