Self-expandable metal stents for achalasia: Thinking out of the box!

Figure 1 Flow diagram of the literature search strategy and valuation of studies identified for review.

Figure 2 Large-diameter self-expandable metallic stent for achalasia. A: Self-expandable metal stents similar to that used by Coppola et al[43]. Picture is provided by courtesy of Mr. Kuhn D, Micro-Tech Europe GmbH, Dusseldorf, Germany; B: Niti-S stent. Picture is provided by courtesy of Mr. Bekzat M, TaeWoong Medical, Seoul, South Korea.

Figure 3 Proposed therapeutic algorithm for achalasia based on surgical risk. Currently established treatments are in bold. Investigational ones are in italics. Arrows indicate current first-line treatments. Lines binding different treatments indicate management of failures. Dotted lines indicate assumed steps in management, while solid lines the to-date recommended[11]. PD: Pneumatic dilation; LHM: Laparoscopic Heller myotomy; BTI: Botulinum toxin injection; twpcSEMS: Temporal, wide, partially covered, self-expandable metallic stent; POEM: Peroral endoscopic myotomy.