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World J Gastroenterol. Sep 7, 2013; 19(33): 5421-5429
Published online Sep 7, 2013. doi: 10.3748/wjg.v19.i33.5421
Published online Sep 7, 2013. doi: 10.3748/wjg.v19.i33.5421
Current status in the treatment options for esophageal achalasia
Seng-Kee Chuah, Wei-Chen Tai, Chi-Sin Changchien, Keng-Liang Wu, Gastrointestinal Motility Unit, Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
Chien-Hua Chiu, Division of General Medicine, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
Hung-I Lu, Division of Thoracic and Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
Jyong-Hong Lee, Digestive Disease Center, Department of Medical Research, Show-Chwan Memorial Hospital, Changhua 500, Taiwan
Ping-Huei Tseng, Department of Internal Medicine, Graduate Institute of Clinical Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan
Author contributions: Chuah SK drafted and wrote the article; Chiu CH, Tai WC, Lee JH, Lu HI, Changchien CS and Tseng PH revised the paper; and Wu KL approved the final version.
Correspondence to: Keng-Liang Wu, MD, Gastrointestinal Motility Unit, Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung 123, Ta-Pei Road, Niaosung Hsiang, Kaohsiung 833, Taiwan. chuahsk@seed.net.tw
Telephone: +886-7-7317123-8301 Fax: +886-7-7322402
Received: April 29, 2013
Revised: June 17, 2013
Accepted: July 4, 2013
Published online: September 7, 2013
Processing time: 133 Days and 9.3 Hours
Revised: June 17, 2013
Accepted: July 4, 2013
Published online: September 7, 2013
Processing time: 133 Days and 9.3 Hours
Core Tip
Core tip: Recent progress in esophageal achalasia includes the use of high-resolution manometry to predict the outcome, the introduction of peroral endoscopic myotomy (POEM). The best current treatment option is an ongoing matter of debate. Unless there are more new conclusive data to prove otherwise, laparoscopic Heller myotomy is the most durable treatment for achalasia at the expense of reflux complications. However, pneumatic dilation (PD) is the first choice for non-surgical treatment and is more cost-effective. Repeated PD according to an “on-demand” strategy based on symptom recurrence can achieve long-term remission. POEM is optimistic but needs more long-term efficacy and safety reports.