Achalasia

Endoscopic therapy for achalasia is centered on disrupting or weakening the lower esophageal sphincter. The three traditional treatment options for achalasia are surgical myotomy, pneumatic dilation, and botulinum toxin injection. Pneumatic dilation yields results that are generally better than botulinum toxin injection and may approach a clinical response comparable with surgery. Per oral endoscopic myotomy is a newer endoscopic modality that will likely change the treatment paradigm for achalasia.

Key Points

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POEM clearly is a paradigm shift in achalasia therapy.
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With POEM, essentially an endoscopic procedure with its associated convenience and less invasiveness can duplicate clinical results of a time-tested surgical procedure (LHM).
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Further refinements of the POEM technique are expected.