Published online Sep 7, 2013. doi: 10.3748/wjg.v19.i33.5421
Revised: June 17, 2013
Accepted: July 4, 2013
Published online: September 7, 2013
Recent advances in the treatment of achalasia include the use of high-resolution manometry to predict the outcome of patients and the introduction of peroral endoscopic myotomy (POEM). The first multicenter randomized, controlled, 2-year follow-up study conducted by the European Achalasia Trial group indicated that laparoscopic Heller myotomy (LHM) was not superior to pneumatic dilations (PD). Publications on the long-term success of laparoscopic surgery continue to emerge. In addition, laparoscopic single-site surgery is applicable to advanced laparoscopic operations such as LHM and anterior fundoplication. The optimal treatment option is an ongoing matter of debate. In this review, we provide an update of the current progress in the treatment of esophageal achalasia. Unless new conclusive data prove otherwise, LHM is considered the most durable treatment for achalasia at the expense of increased reflux-associated complications. However, PD is the first choice for non-surgical treatment and is more cost-effective. Repeated PD according to an “on-demand” strategy based on symptom recurrence can achieve long-term remission. Decision making should be based on clinical evidence that identifies a subcategory of patients who would benefit from specific treatment options. POEM has shown promise but its long-term efficacy and safety need to be assessed further.
Core tip: Recent progress in esophageal achalasia includes the use of high-resolution manometry to predict the outcome, the introduction of peroral endoscopic myotomy (POEM). The best current treatment option is an ongoing matter of debate. Unless there are more new conclusive data to prove otherwise, laparoscopic Heller myotomy is the most durable treatment for achalasia at the expense of reflux complications. However, pneumatic dilation (PD) is the first choice for non-surgical treatment and is more cost-effective. Repeated PD according to an “on-demand” strategy based on symptom recurrence can achieve long-term remission. POEM is optimistic but needs more long-term efficacy and safety reports.