The Kagoshima consensus on esophageal achalasia

Abstract

Esophageal achalasia is a primary esophageal motility disorder characterized by lack of peristalsis and a lower esophageal sphincter that fails to relax appropriately in response to swallowing. This article summarizes the most salient issues in the diagnosis and management of achalasia as discussed in a symposium that took place in Kagoshima, Japan, in September 2010 under the auspices of the International Society for Diseases of the Esophagus.

Peroral endoscopic myotomy for treatment of achalasia: from bench to bedside (with video)

“…16 The Kagoshima consensus on achalasia recommended that a surgical myotomy extend 4 to 5 cm into the esophagus and 2 to 3 cm into the stomach. 17 A shorter myotomy or a myotomy without extension to gastric cardia could result in early recurrence of dysphagia. The optimal length of myotomy after POEM is still debatable, but an extensive myotomy for the current procedure aimed to ensure adequate symptomatic relief.…”

Prior treatment does not influence the performance or early outcome of per-oral endoscopic myotomy for achalasia

“…This impairs esophageal emptying and classically presents as dysphagia for solids and liquids and regurgitation of undigested food [1,2]. Once diagnosed, most patients undergo pneumatic dilation, botulinum toxin injection or surgical myotomy as medical therapies (calcium channel blockers and nitrates) are rarely effective.…”

Therapeutic options in oesophageal dysphagia

“…20 Injection schemes show major variations, ranging between 50 and 200 international units delivered at the cardia or also in the segment above. 21 However, the therapeutic effect of botulinium toxin wears off quickly in many patients: a meta-analysis found symptomatic response rates after a single injection of 78.7% at 1 month, 70% at 3 months, 53.3% at 6 months, and 40.6% at 12 months. 19 Table 1 summarizes studies comparing botulinum toxin injection to pneumatic dilation in achalasia.…”

“…22 On the basis of these limitations, it has been recommended to use botulinum toxin injection only in elderly patients and patients with comorbidities, who are not candidates for more effective treatments. 21 Pneumatic dilation Pneumatic dilation is still considered the gold-standard nonsurgical treatment modality in achalasia. Although details of the dilation procedure vary between institutions, the aim is to obtain mechanical disruption of the muscle fibres at the EGJ.…”