Published online Sep 16, 2014. doi: 10.4253/wjge.v6.i9.407
Revised: July 8, 2014
Accepted: July 18, 2014
Published online: September 16, 2014
Esophageal achalasia is a chronic and progressive motility disorder characterized by absence of esophageal body peristalsis associated with an impaired relaxation of lower esophageal sphincter (LES) and usually with an elevated LES pressure, leading to an altered passage of bolus through the esophago-gastric junction. A definitive cure for achalasia is currently unavailable. Palliative treatment options provide only food and liquid bolus intake and relief of symptoms. Endoscopic therapy for achalasia aims to disrupt or weaken the lower esophageal sphincter. Intra-sphincteric injection of botulinum toxin is reserved for elderly or severely ill patients. Pneumatic dilation provides superior results than botulinum toxin injection and a similar medium-term efficacy almost comparable to that attained after surgery. Per oral endoscopic myotomy is a promising option for treating achalasia, but it requires increased experience and further objective and long-term follow up. This article will review different endoscopic treatments in achalasia, and summarize the short-term and long-term outcomes.
Core tip: No definitive treatments of achalasia are currently available. Palliative treatment options aims to relieve symptoms and to help patients for food and liquid intake. Endoscopic approach to achalasia is directed to disrupt or weaken the lower esophageal sphincter. On the other hand, intra-sphincteric injection of botulinum toxin is reserved for elderly or severely ill patients. Pneumatic dilation provides better results than botulinum toxin injection and a clinical benefit comparable to surgery. Per oral endoscopic myotomy is a promising option but it requires increased experience and further objective and long-term follow up.