Achalasia.
Surgical therapy (Heller myotomy) is the most effective treatment to relieve dysphagia associated with achalasia. The advent of minimally invasive techniques, specifically the laparoscopic approach, significantly reduced the morbidity of surgical therapy, making it the procedure of choice for most patients who have achalasia. Pneumatic dilatation is a viable alternative, though is associated with inferior results and a higher risk of esophageal perforation than surgical therapy. Pharmacotherapy and Botox provide inferior results and should be reserved for temporizing therapy, or for patients who are deemed too frail for surgical intervention. For best results, a laparoscopic myotomy should be carried at least 3 cm onto the stomach, and a partial fundoplication should be performed to reduce the incidence of postoperative GE reflux.
Woltman
Todd A
TA
Department of Surgery, University of Washington, 1959 NE Pacific Street, Box 356410, Seattle, WA 98195-6410, USA.
Pellegrini
Carlos A
CA
Oelschlager
Brant K
BK
D001465:Barium Radioisotopes; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D003680:Deglutition Disorders / Q000175:diagnosis; D003937:Diagnosis, Differential; D004106:Dilatation / Q000295:instrumentation; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D004945:Esophagoscopy / Q000379:methods*; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D008365:Manometry / Q000379:methods; D009465:Neuromuscular Agents / Q000627:therapeutic use; D013906:Thoracoscopy / Q000379:methods
D001465:Barium Radioisotopes; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A