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World J Gastrointest Endosc. Sep 16, 2014; 6(9): 407-414
Published online Sep 16, 2014. doi: 10.4253/wjge.v6.i9.407
Published online Sep 16, 2014. doi: 10.4253/wjge.v6.i9.407
Recent trends in endoscopic management of achalasia
Salvatore Tolone, Paolo Limongelli, Gianmattia del Genio, Luigi Brusciano, Antonio Russo, Lorenzo Cipriano, Marco Terribile, Giovanni Docimo, Roberto Ruggiero, Ludovico Docimo, XI Division of General and Obesity Surgery, Second University of Naples, 80131 Naples, Italy
Author contributions: Tolone S and Limongelli P shared co-first authorship; Tolone S and Limongelli P contributed equally to this work; Tolone S and Limongelli P contributed to concept, design and drafting the article; del Genio G, Brusciano L, Russo A, Cipriano L, Terribile M, Docimo G and Ruggiero R contributed to acquisition and interpretation of data, and revised it critically for important intellectual content; Docimo L gave final approval of the version to be published.
Correspondence to: Paolo Limongelli, MD, PhD, XI Division of General and Obesity Surgery, Second University of Naples, Via Pansini, 5, 80131 Naples, Italy. paolo.limongelli@unina2.it
Telephone: +39-08-15666237 Fax: +39-08-15666669
Received: February 24, 2014
Revised: July 8, 2014
Accepted: July 18, 2014
Published online: September 16, 2014
Revised: July 8, 2014
Accepted: July 18, 2014
Published online: September 16, 2014
Core Tip
Core tip: No definitive treatments of achalasia are currently available. Palliative treatment options aims to relieve symptoms and to help patients for food and liquid intake. Endoscopic approach to achalasia is directed to disrupt or weaken the lower esophageal sphincter. On the other hand, intra-sphincteric injection of botulinum toxin is reserved for elderly or severely ill patients. Pneumatic dilation provides better results than botulinum toxin injection and a clinical benefit comparable to surgery. Per oral endoscopic myotomy is a promising option but it requires increased experience and further objective and long-term follow up.