Achalasia Treatment in Patients over 80 Years of Age: A Multicenter Survey

Zotti, Orlando Rondan; Herbella, Fernando A. M.; Armijo, Priscila Rodrigues; Oleynikov, Dmitry; Aquino, José Luiz Braga de; Leandro‐Merhi, Vânia Aparecida; Velanovich, Vic; Salvador, Renato; Costantini, Mario; Low, Donald E.; Wirsching, Andrea; Boshier, Piers R.; Kristem, Leonardo; Gurski, Richard R; Patti, Marco G.

doi:10.1089/lap.2019.0749

Cited by 2 publications

(2 citation statements)

References 14 publications

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“…A retrospective study from England, including 6938 achalasia patients treated by PD or surgical Heller’s myotomy showed that mortality after PD was associated with increasing age, comorbidities, previous Heller’s myotomy and repeated PD [ 29 ]. On their multicenter survey of patients over 80 years of age, Zotti et al showed that most specialized centers do not tailor treatment based on age, but on their physiological and mental health, and that endoscopic treatment has a high recurrence rate [ 30 ].…”

Section: Treatment Optionsmentioning

confidence: 99%

“…LHM was performed in 20 patients with good clinical response and a very low complications rate. One major highlight from this survey is the fact that physicians from experienced high-volume centers did not mould treatment solely based on advanced age and proposed that LHM appears to be a reasonable therapeutic option, with good clinical outcomes and safety profiles, in this population [ 30 ]. Put all together, based on the data presented here and counting the enormous worldwide experience with LHM in elderly patients, this option seems to be practical, effective and safe in elderly fit patients.…”

Section: Surgical Treatmentmentioning

confidence: 99%

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Achalasia in the Elderly: Diagnostic Approach and a Proposed Treatment Algorithm Based on a Comprehensive Literature Review

Mari

Sbeit

Abboud

et al. 2021

JCM

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Achalasia is not uncommonly diagnosed in elderly patients and its incidence and prevalence are growing in this population. However, a scarcity of studies has assessed the typical pathophysiological and clinical features of the disease as well as the effectiveness and safety of the various therapeutic options in elderly populations. Botulinum toxin injection has been used for achalasia treatment since 1994 and is traditionally considered the preferred treatment for fragile elder patients. However, recently more evidence has become available regarding the safety and effectiveness of pneumatic balloon dilation (BD), laparoscopic Heller myotomy (LHM) and per-oral endoscopic myotomy (POEM) in elderly patients with achalasia. In the current review we present the current literature on this topic with a focus on the clinical presentation of achalasia in the elderly and manometric features thereof, as well as summarize the effectiveness and safety of the various therapeutic options. Furthermore, we propose a practical management algorithm as a means to guide the treatment of future cases. We recommend that a conservative/BTI approach should be adopted in the fragile unfit patient. In the elderly fit patient, the treatment decision should be based on the achalasia type, patient preference and the available expertise, similar to the approach adopted for the non-elderly population.

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Section: Treatment Optionsmentioning

confidence: 99%

Section: Surgical Treatmentmentioning

confidence: 99%