New insights into the pathophysiology of achalasia and implications for future treatment

Table 1 Current treatment options in achalasia

Treatment option	Pros	Cons	Success rate
Oral agents	Non operative patients, on demand, dose adjustment	Adverse events, low duration, not a definitive method	28%-66% reduction of LES pressure
Pneumatic dilation	Short recovery, low procedure time, best non-surgical method	Perforation, multiple procedures needed, post procedure reflux	66%-90% 1 yr and 48% 10 yr
Heller myotomy	Most durable effect	Not applicable for high risk surgical patients, post-surgical reflux, anesthesia required	93% 1 yr
			69%-80% 10 yr
Self-expanding metal stent	Good palliative option, high risk surgical patients	Expensive, stent migration, reflux (single center experience)	100% 1 mo,
			83% 10 yr
POEM	Non-surgical, -low and -high risk patients	Complications (pneumothorax, reflux), not widely available, expertise	5%-62% reduction of LES pressure

Modified from Krill et al[90] and Dobrowolsky et al[92].