Peroral Endoscopic Myotomy as A Potential Alternative to Heller Myotomy and Pneumatic Dilation for the Treatment of Achalasia
Abstract:
Achalasia cardia is an esophageal motility disorder diagnosed with high-resolution manometry and cate gorized into type I, II and III. The mainstay treatment is laparoscopic Heller myotomy (LH), however many interventions have been introduced for achalasia management including pneumatic dilation (PD) and the newly emerging peroral endoscopic myotomy (POEM). In this review, we focus on the three main inter ventions that current guidelines suggest as safe and effective treatment options for achalasia; PD, LH and POEM. Both PD and LH are comparable for the management of achalasia type I and type II, while POEM utilizes natural orifice transluminal endoscopic surgery (NOTES) techniques and has gained increasing at tention due to similar clinical success rates to those of the traditional interventions. However, an increased incidence of post-procedural gastroesophageal reflux (GERD) has been reported in the literature. Many studies have compared GERD between the different treatment modalities and the available antireflux inter ventions. Although the data are still conflicting, GERD can be prevented and, additionally, it seems to wane over time. This may make POEM potentially the optimal choice for the treatment of achalasia.
