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Expert Rev Gastroenterol Hepatol. 2014 Sep;8(7):767-73. doi: 10.1586/17474124.2014.910452. Epub 2014 Apr 26.

Achalasia: advances in treatment.

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Uniklinikum Großhadern, Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Marchioninistraße 15 D-81377 München, Munich, Germany.


Achalasia is a primary esophageal motility disorder, which shows distinct clinical, manometric, radiologic, and pathologic features. Available treatment strategies are pharmacological, endoscopic or surgical. In the past decades preferred treatment has alternated between surgical myotomy (presently Laparoscopic Heller Myotomy [LHM]) and endoscopic balloon dilation (EBD). While surgical myotomy promises superior long-term results and significantly less retreatment, endoscopic balloon dilation is initially far less invasive and yields comparable results after redilation. Peroral Endoscopic Myotomy (POEM) aims to combine the minimal invasive approach through the mouth with the better long-term results after LHM. Initial findings in the literature point to comparable success-rates after POEM and LHM. In the literature complication rates are similar to those obtained after surgery. This new interventional technique should be subject to randomized controlled trials and compared to EBD and LHM.


achalasia; endoscopic balloon dilation; esophagus; laparoscopic surgery; motility disorder; peroral endoscopic myotomy

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