Treatment of idiopathic achalasia with per-oral esophageal myotomy

Ryan A.J. Campagna*, Eric S. Hungness

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

5 Scopus citations

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 languageEnglish (US)
Pages (from-to)114-119
Number of pages6
JournalTechniques in Gastrointestinal Endoscopy
Volume20
Issue number3
DOIs
StatePublished - 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

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