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World J Gastrointest Endosc. Jan 16, 2015; 7(1): 45-52
Published online Jan 16, 2015. doi: 10.4253/wjge.v7.i1.45
Self-expandable metal stents for achalasia: Thinking out of the box!
Athanasios D Sioulas, Chrysoula Malli, George D Dimitriadis, Konstantinos Triantafyllou
Athanasios D Sioulas, Chrysoula Malli, George D Dimitriadis, Konstantinos Triantafyllou, Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Medical School, Athens University, 12462 Haidari, Greece
Author contributions: Sioulas AD searched the literature, drafted and finally approved the manuscript; Malli C searched the literature, reviewed the draft and finally approved the manuscript; Dimitriadis GD reviewed the draft and finally approved the manuscript; Triantafyllou K conceived the idea, reviewed the draft and finally approved the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Konstantinos Triantafyllou, Assistant Professor of Gastroenterology, Hepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Attikon University General Hospital, Rimini 1, 12462 Haidari, Greece. ktriant@med.uoa.gr
Telephone: +30-210-5832090 Fax: +30-210-5326422
Received: August 22, 2014
Peer-review started: August 22, 2014
First decision: September 16, 2014
Revised: October 4, 2014
Accepted: November 7, 2014
Article in press: November 10, 2014
Published online: January 16, 2015
Abstract

Achalasia is a primary motor disorder of the esophagus diagnosed manometrically in the clinical setting of dysphagia to both solids and liquids. Currently established treatment options include pneumatic dilation, laparoscopic Heller myotomy, botulinum toxin injection performed endoscopically, oral agents that relax the lower esophageal sphincter and esophagectomy for refractory, end-stage disease. Despite their effectiveness, a significant proportion of patients eventually relapses and needs retreatment. In this setting, several new techniques are under investigation promising future enrichment of our therapeutic armamentarium for achalasic patients. Among them, peroral endoscopic myotomy and self-expandable metal stents placed across the gastro-esophageal junction represent the most encouraging modalities, as initial studies assessing their efficacy and safety indicate. This review highlights the role of self-expandable metal stents in the management of patients with achalasia. Their possible position in the therapeutic algorithm of achalasia along with established and novel techniques is also assessed. Finally, the need for large prospective randomized trials is underlined in order to elucidate the numerous relevant issues.

Keywords: Achalasia, Self-expandable metal stents, Dysphagia, Endoscopy, Treatment

Core tip: Recommended treatment of patients with achalasia are associated with significant clinical relapse over subsequent months or years. Therefore, numerous innovative techniques are under evaluation. Self-expandable metal stents may represent a promising alternative according to initial studies. They may gain a place in the therapeutic algorithm of achalasia in the view of its different types and stages, patients’ characteristics and other emerging modalities.