ASGE guideline on the management of achalasia

Current and Future Treatment Options in Primary Achalasia. The Role of POEM

“…During recent years a number of systematic reviews and meta-analyses have been carried out [32][33][34][35][36][37][38][39][40][41][42][43][44]. In those, 28 studies (2 RCTs and 26 observational studies) have been included.…”

Creation of a third space endoscopy program at a tertiary academic US medical center

“…A cost comparison study by Miller et al 17 showed that while cost of a single pneumatic dilation of the lower esophageal sphincter may be less than that of a POEM, the long term costs of pneumatic dilation exceed that of POEM due to the need for recurrent dilations and hospitalizations for uncontrolled symptoms. 16,17 Understanding of this long-term gain by institutional leadership is imperative in order to receive funding for equipment as well as colleague and staff support. Mutual respect, understanding and support from surgical subspecialties is needed given that third space endoscopy procedures are able to treat diseases historically treated with surgery.…”

Achalasia: what to do in the face of failures of Heller myotomy

“…6,7 The mechanism of action for PD is the disruption of the muscle fibers of the LES utilizing a pressurized balloon and, often, fluoroscopic guidance. 8 Progressive dilation is carried out using balloon sizes of 30-, 35-, and 40-mm diameter based on provider comfort level and patient response. 8 In a recently published metaanalysis of 52 uncontrolled studies, "clinical success, defined by an Eckardt score ≤ 3, was achieved in 83% over a follow-up period ranging from 3 to 6 months."…”

“…8 Progressive dilation is carried out using balloon sizes of 30-, 35-, and 40-mm diameter based on provider comfort level and patient response. 8 In a recently published metaanalysis of 52 uncontrolled studies, "clinical success, defined by an Eckardt score ≤ 3, was achieved in 83% over a follow-up period ranging from 3 to 6 months." 8 Importantly, there was a statistically significant decrease in the average LES pressure after PD (34.47 versus 20.80 mm Hg, P < 0.01).…”

“…8 Importantly, there was a statistically significant decrease in the average LES pressure after PD (34.47 versus 20.80 mm Hg, P < 0.01). 8 One difficulty with evaluating the benefit of PD is that studies are inconsistent in the PD treatment algorithm-in particular, there is an inconsistency in the balloon size utilized, the number of repeat interventions, and time between attempted dilations. 5 The most feared complication of PD is transmural perforation-a systematic review reports contemporary perforation rates <1%, similar to the unrecognized perforation rate during surgical myotomy 1 ; however, many other studies report slightly higher rates of perforation.…”