Luján-Sanchis M, Suárez-Callol P, Monzó-Gallego A, Bort-Pérez I, Plana-Campos L, Ferrer-Barceló L, Sanchis-Artero L, Llinares-Lloret M, Tuset-Ruiz JA, Sempere-Garcia-Argüelles J, Canelles-Gamir P, Medina-Chuliá E. Management of primary achalasia: The role of endoscopy. World J Gastrointest Endosc 2015; 7(6): 593-605 [PMID: 26078828 DOI: 10.4253/wjge.v7.i6.593]
Corresponding Author of This Article
Marisol Luján-Sanchis, MD, Digestive Diseases Unit, General University Hospital of Valencia, Avenida Tres Cruces, 2, 46014 Valencia, Spain. marisol.lujan@hotmail.es
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
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/
World J Gastrointest Endosc. Jun 10, 2015; 7(6): 593-605 Published online Jun 10, 2015. doi: 10.4253/wjge.v7.i6.593
Management of primary achalasia: The role of endoscopy
Marisol Luján-Sanchis, Patricia Suárez-Callol, Ana Monzó-Gallego, Inmaculada Bort-Pérez, Lydia Plana-Campos, Luis Ferrer-Barceló, Laura Sanchis-Artero, María Llinares-Lloret, Juan Antonio Tuset-Ruiz, Javier Sempere-Garcia-Argüelles, Pilar Canelles-Gamir, Enrique Medina-Chuliá
Author contributions: Luján-Sanchis M, Suárez-Callol P, Monzó-Gallego A and Bort-Pérez I contributed equally to this work designing and writing the review and with the final approval of the version to be published; Plana-Campos L designed the algorithms; Ferrer-Barceló L and Sanchis-Artero L wrote part of the review; Llinares-Lloret M made the illustrations; Tuset-Ruiz JA, Sempere-Garcia-Argüelles J, Canelles-Gamir P and Medina-Chuliá E contributed equally revising the article for intellectual content and with the final approval of the version to be published.
Conflict-of-interest: All authors declare any conflicting interests (including but not limited to commercial, personal, political, intellectual, or religious interests).
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: Marisol Luján-Sanchis, MD, Digestive Diseases Unit, General University Hospital of Valencia, Avenida Tres Cruces, 2, 46014 Valencia, Spain. marisol.lujan@hotmail.es
Telephone: +34-96-3131800 Fax: +34-96-1972148
Received: August 28, 2014 Peer-review started: August 31, 2014 First decision: November 3, 2014 Revised: January 28, 2015 Accepted: February 9, 2015 Article in press: February 11, 2015 Published online: June 10, 2015
Abstract
Achalasia is an oesophageal motor disorder which leads to the functional obstruction of the lower oesophageal sphincter (LES) and is currently incurable. The main objective of all existing therapies is to achieve a reduction in the obstruction of the distal oesophagus in order to improve oesophageal transit, relieve the symptomatology, and prevent long-term complications. The most common treatments used are pneumatic dilation (PD) and laparoscopic Heller myotomy, which involves partial fundoplication with comparable short-term success rates. The most economic non-surgical therapy is PD, with botulinum toxin injections reserved for patients with a higher surgical risk for whom the former treatment option is unsuitable. A new technology is peroral endoscopic myotomy, postulated as a possible non-invasive alternative to surgical myotomy. Other endoluminal treatments subject to research more recently include injecting ethanolamine into the LES and using a temporary self-expanding metallic stent. At present, there is not enough evidence permitting a routine recommendation of any of these three novel methods. Patients must undergo follow-up after treatment to guarantee that their symptoms are under control and to prevent complications. Most experts are in favour of some form of endoscopic follow-up, however no established guidelines exist in this respect. The prognosis for patients with achalasia is good, although a recurrence after treatment using any method requires new treatment.
Core tip: We propose a treatment and monitoring algorithm for achalasia based on the most relevant published evidence and an exhaustive summary of all the available endoscopic techniques.
