Insights into the endoscopic management of esophageal achalasia

Abstract

Achalasia is a primary esophageal motility disorder characterized by the loss of inhibitory neurons in the myenteric plexus, resulting in impaired relaxation of the esophagogastric junction. Achalasia is an incurable disease, and the treatment modalities are aimed at disruption of the esophagogastric junction and vary widely from pharmacological to endoscopic to surgical. Traditional endoscopic therapy includes pneumatic dilation, botulinum toxin injection, and peroral endoscopic myotomy. This review aims to provide an overview of the endoscopic management of achalasia, while focusing on the utilization of peroral endoscopic myotomy and other novel approaches.

Peroral Endoscopic Myotomy

“…This surgical intervention has high rates of success and fairly low complication rates (Ngamruengphong et al, 2017). However, considerable interest and excitement of POEMs for achalasia treatment were derived from the emergence of natural orifice transluminal endoscopic surgery (NOTES) (Brindise et al, 2021).…”

“…Additional novel treatment includes therapeutic application of a hydrostatic dilation balloon (3–30 mm as indicated for achalasia), using high-resolution impedance planimetry with an esophageal functional luminal imaging probe called EsoFLIP (Medtronic Inc, Shoreview, Minnesota) (Brindise et al, 2021). The EsoFLIP is conducted concomitant EGD by advancing a catheter into the esophagus transorally and positioned as volume-controlled distention of the balloon occurs incrementally while visualizing a real-time three-dimensional monitor (Pannala et al, 2022).…”

“…

a chalasia Presents as a Rare Disorder, affecting only 0.3-1.63 per 100,000 adults yearly, worldwide (Sadowski, ackah, Jiang, & Svenson, 2010). In the United States, it is estimated that 20,000-40,000 patients are affected by it, occurring equally amongst genders (Vaezi, Pandolfino, yadlapati, Greer, & Kavitt, 2020) with no racial correlation (Brindise, Khashab, & El abiad, 2021). Classic symptoms of achalasia include heartburn, dysphagia, regurgitation (Brindise et al, 2021), chest pain, and weight loss (Chadalavada, Thota, Raja, & Sanaka, 2020).

…”

“…In the United States, it is estimated that 20,000-40,000 patients are affected by it, occurring equally amongst genders (Vaezi, Pandolfino, yadlapati, Greer, & Kavitt, 2020) with no racial correlation (Brindise, Khashab, & El abiad, 2021). Classic symptoms of achalasia include heartburn, dysphagia, regurgitation (Brindise et al, 2021), chest pain, and weight loss (Chadalavada, Thota, Raja, & Sanaka, 2020). achalasia is the leading indication for performance of peroral endoscopic myotomy to alleviate its symptoms, more frequently referred to by the acronym "POEM" (Chadalavada et al, 2020).…”

Evaluating the Non-conventional Achalasia Treatment Modalities

“…100 units of BTX above gastroesophageal junction are enough to produce the desired effect and can be performed as a day case procedure. (37).…”