Clinical Endoscopy

Role of endoscopy in patients with achalasia: So Young Han, Young Hoon Youn; Clin Endosc 2023;56(5):537-545. Published online June 2, 2023; DOI: https://doi.org/10.5946/ce.2023.001

Achalasia is an esophageal motility disorder characterized by impaired lower esophageal sphincter relaxation and peristalsis of the esophageal body. With the increasing prevalence of achalasia, interest in the role of endoscopy in its diagnosis, treatment, and monitoring is also growing. The major diagnostic modalities for achalasia include high-resolution manometry, esophagogastroduodenoscopy, and barium esophagography. Endoscopic assessment is important for early diagnosis to rule out diseases that mimic achalasia symptoms, such as pseudo-achalasia, esophageal cancer, esophageal webs, and eosinophilic esophagitis. The major endoscopic characteristics suggestive of achalasia include a widened esophageal lumen and food residue in the esophagus. Once diagnosed, achalasia can be treated either endoscopically or surgically. The preference for endoscopic treatment is increasing owing to its minimal invasiveness. Botulinum toxins, pneumatic balloon dilation, and peroral endoscopic myotomy (POEM) are important endoscopic treatments. Previous studies have demonstrated excellent treatment outcomes for POEM, with >95% improvement in dysphagia, making POEM the mainstay treatment option for achalasia. Several studies have reported an increased risk of esophageal cancer in patients with achalasia. However, routine endoscopic surveillance remains controversial owing to the lack of sufficient data. Further studies on surveillance methods and duration are warranted to establish concordant guidelines for the endoscopic surveillance of achalasia.

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Clinical Endoscopy.2024; 57(3): 293. CrossRef
Case of Concomitant Endoscopic Treatment of Achalasia with Superficial Esophageal Cancer
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Peroral Endoscopic Myotomy for Esophageal Motility Disorders: Jun Young Kim, Yang Won Min; Clin Endosc 2020;53(6):638-645. Published online November 20, 2020; DOI: https://doi.org/10.5946/ce.2020.223

Abstract PDF PubReader ePub

Peroral endoscopic myotomy (POEM) is one of the most clinically successful tunnel-based minimally invasive endoscopic treatments. The classic indications of POEM include achalasia of all types, including failed prior treatments, and expanded indications include the non-achalasia esophageal motility disorders, such as esophagogastric junction outflow obstruction, diffuse esophageal spasm, and jackhammer esophagus. For achalasia treatment, POEM has achieved a comparable surgical efficacy and a safety outcome and, therefore, has emerged as a first-line treatment. For non-achalasia esophageal motility disorders, POEM has also shown high clinical response rates. The complication rate of POEM for esophageal motility disorders is low and most complications are managed with conservative treatment. Currently, POEM is a representative procedure of natural orifice transluminal endoscopic surgery, which has shown a good clinical efficacy with low complication rates for esophageal motility disorders including achalasia. However, further studies are needed to treat non-achalasia motility disorder via POEM.

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Citations to this article as recorded by

Diffuse Esophageal Spasm: An Alternative Treatment Approach
McKenzie K Allen , Wayne Frei
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Clinical and financial outcomes of per-oral endoscopic myotomy compared to laparoscopic heller myotomy for treatment of achalasia
Lena Shally, Kashif Saeed, Derek Berglund, Mark Dudash, Katie Frank, Vladan N. Obradovic, Anthony T. Petrick, David L. Diehl, Jon D. Gabrielsen, David M. Parker
Surgical Endoscopy.2023; 37(7): 5526. CrossRef
Benefit of extending the protocol for high resolution manometry according to the version 4.0 of the Chicago criteria. A multicenter study
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Role of Endoscopy in Motility Disorders of Upper Gastrointestinal Tract
Jin Hee Noh, Hwoon-Yong Jung
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Foregut: The Journal of the American Foregut Society.2023; 3(1): 89. CrossRef
Per oral endoscopic myotomy for achalasia: A Taiwanese single‐center experience
Yu‐Chi Lee, Wei‐Chen Tai, Keng‐Liang Wu, Chih‐Chien Yao, Seng‐Kee Chuah
Advances in Digestive Medicine.2022; 9(4): 241. CrossRef
Pediatric anesthesia and achalasia: 10 years’ experience in peroral endoscopy myotomy management
Fabio Sbaraglia, Pietro Familiari, Federica Maiellare, Marco Mecarello, Annamaria Scarano, Demetrio Del Prete, Rosa Lamacchia, Federica Antonicelli, Marco Rossi
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A rare complication: Tension pneumothorax after peroral endoscopic myotomy
Seokin Kang, Yuri Kim, Do Hoon Kim
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Min Ji Kim, Yang Won Min
The Korean Journal of Gastroenterology.2021; 77(2): 77. CrossRef
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Two-Stage Peroral Endoscopic Myotomy for Sigmoid-Type Achalasia: Hak Su Kim, Hee Kyung Kim, Weon Jin Ko; Clin Endosc 2020;53(2):232-235. Published online July 16, 2019; DOI: https://doi.org/10.5946/ce.2019.067

Abstract PDF Supplementary Material PubReader ePub: Peroral endoscopic myotomy (POEM) has been recently considered as the first treatment option for achalasia. The standard POEM procedures are often successful in most patients, but sometimes technical challenges are encountered. We report a new technique that is divided between two tunneling sites in the esophagus for sigmoid-type achalasia. A 40-year-old male patient with dysphagia for 10 years was diagnosed with a sigmoid-shaped esophagus at our hospital. We devised a two-stage myotomy technique to treat sigmoidtype achalasia. The myotomy was first performed in the upper part of the greater flexion area and then in the lower part of the flexion. We termed this method “two-stage POEM”, which was successfully performed without any complications. This new POEM method can also be used to improve symptoms in patients with achalasia who have a structural deformity that may result in a high change of treatment failure.

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