How to Endoscopically Treat Achalasia: to Balloon, Inject, or Incise?

AbstractPurpose of reviewAchalasia is a primary esophageal motility disorder characterized by abnormal peristalsis and impaired relaxation of the esophagogastric junction (EGJ). It is a heterogenous disease with no definitive cure. Endoscopic therapies include botulinum toxin injection (BTI), pneumatic dilation (PD), and peroral endoscopic myotomy (POEM). Recent literature debates which intervention befits which patient population. In this review, we will provide an overview of these endoscopic treatment options and discuss the recent advancements in the domain.Recent findingsPneumatic dilation is often the first treatment option utilized for patients with achalasia. There have been numerous studies proving its efficacy; however, the effect frequently wanes with time requiring multiple repeat treatments. Research has focused on the appropriate balloon size, targeted inflation pressure, number of dilation sessions, and timing between dilations. Unfortunately, despite the research, no consensus has been reached. The novel EsoFLIP device has transformed the horizon for PD allowing tailored and controlled dilations providing objective parameters for the clinician. Botulinum toxin injections continue to be recommended for patients with achalasia, particularly those who are medically unfit for more robust therapy. Over the past 3 years, however, research regarding BTI remained idle with no breakthrough findings or new information to modify these recommendations. POEM was introduced...
Source: Current Treatment Options in Gastroenterology - Category: Gastroenterology Source Type: research