title: Current status in the treatment options for esophageal achalasia.
abstract: Recent advances in the treatment of achalasia include the use of high-resolution manometry to predict the outcome of patients and the introduction of peroral endoscopic myotomy (POEM). The first multicenter randomized, controlled, 2-year follow-up study conducted by the European Achalasia Trial group indicated that laparoscopic Heller myotomy (LHM) was not superior to pneumatic dilations (PD). Publications on the long-term success of laparoscopic surgery continue to emerge. In addition, laparoscopic single-site surgery is applicable to advanced laparoscopic operations such as LHM and anterior fundoplication. The optimal treatment option is an ongoing matter of debate. In this review, we provide an update of the current progress in the treatment of esophageal achalasia. Unless new conclusive data prove otherwise, LHM is considered the most durable treatment for achalasia at the expense of increased reflux-associated complications. However, PD is the first choice for non-surgical treatment and is more cost-effective. Repeated PD according to an "on-demand" strategy based on symptom recurrence can achieve long-term remission. Decision making should be based on clinical evidence that identifies a subcategory of patients who would benefit from specific treatment options. POEM has shown promise but its long-term efficacy and safety need to be assessed further.
authors.affiliation: Seng-Kee Chuah, Wei-Chen Tai, Chi-Sin Changchien, Keng-Liang Wu, Gastrointestinal Motility Unit, Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan.
authors.forename: Seng-Kee
authors.initials: SK
authors.lastname: Chuah
authors.forename: Chien-Hua
authors.initials: CH
authors.lastname: Chiu
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Tai
authors.forename: Jyong-Hong
authors.initials: JH
authors.lastname: Lee
authors.forename: Hung-I
authors.initials: HI
authors.lastname: Lu
authors.forename: Chi-Sin
authors.initials: CS
authors.lastname: Changchien
authors.forename: Ping-Huei
authors.initials: PH
authors.lastname: Tseng
authors.forename: Keng-Liang
authors.initials: KL
authors.lastname: Wu
mesh_terms: D003657:Decision Making; D004931:Esophageal Achalasia / Q000628:therapy*; D004945:Esophagoscopy; D006801:Humans; D008365:Manometry; D012008:Recurrence; D012307:Risk Factors
keywords: Botulinum injection; Endoscopic pneumatic dilations; Esophageal achalasia; Minimally invasive Heller myotomy; Peroral endoscopic myotomy
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