Advances and caveats in modern achalasia management.
Laparoscopic Heller myotomy
Peroral endoscopic myotomy
dysphagia
esophageal achalasia
esophago-gastric junction Outflow Obstruction
graded pneumatic dilatation
high resolution manometry
timed barium swallow
Journal
Therapeutic advances in chronic disease
ISSN: 2040-6223
Titre abrégé: Ther Adv Chronic Dis
Pays: United States
ID NLM: 101532140
Informations de publication
Date de publication:
2021
2021
Historique:
received:
19
08
2020
accepted:
15
01
2021
entrez:
31
3
2021
pubmed:
1
4
2021
medline:
1
4
2021
Statut:
epublish
Résumé
Achalasia is a rare esophageal motility disorder characterized by the incomplete relaxation of the lower esophageal sphincter (LES) and impaired peristaltic activity. The advent of high-resolution manometry (HRM) and the rapidly evolving role of therapeutic endoscopy have revolutionized the approach to the diagnosis and management of achalasia patients in the last decade. With advances in HRM technology and methodology, fluoroscopy and EndoFlip, achalasia can be differentiated into therapeutically meaningful phenotypes with a high degree of accuracy. Further, the newest treatment option, per-oral endoscopic myotomy (POEM), has become a staple therapy following the last 10 years of experience, and recent randomized trials appear to show no difference between POEM, graded pneumatic dilatation and surgical Heller myotomy in terms of short- and long-term efficacy or complication rate. On the other hand, how treatment outcomes are measured as well as the risk of reflux following therapy remain areas of contention. This review aims to summarize the recent advancements in achalasia testing and therapy, describes the recent randomized clinical trials as well as their potential setbacks, and touches on the future of personalizing achalasia treatment.
Identifiants
pubmed: 33786159
doi: 10.1177/2040622321993437
pii: 10.1177_2040622321993437
pmc: PMC7958157
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
2040622321993437Informations de copyright
© The Author(s), 2021.
Déclaration de conflit d'intérêts
Conflict of interest statement: The authors declare that there is no conflict of interest.
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