title: Pneumatic dilation and botulinum toxin: when and why?
abstract: Pneumatic dilation and botulinum toxin:when and why? The endoscopic treatment options of achalasia include botulinum toxin (BT) injection and pneumatic dilation (PD) of the lower esophageal sphincter (LES). BT can reduce the LES pressure by blocking the release of acetylcoline from presynaptic cholinergic nerve terminals in the myenteric plexus. Although the procedure is safe and good initial response is reported, there is a wide variability in the duration of the response and the effect tends to decrease over time. BT is usually recommended for elderly patients or patients with comorbid illnesses, who are poor candidates for more invasive procedures. PD aims at tearing the muscle fibers of the LES and is considered the most effective nonsurgical treatment for achalasia. Technical details of the procedure vary in different institutions and in many clinical settings the choice between PD or minimally invasive surgical myotomy depends upon local expertise in the procedures. Further endoscopic treatment options such as submucosal esophageal myotomy or self-expanding metallic stents are being studied.
authors.forename: Rosamaria
authors.initials: R
authors.lastname: Bozzi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Di Martino
authors.forename: Antonio
authors.initials: A
authors.lastname: Inzirillo
authors.forename: Eugenio
authors.initials: E
authors.lastname: D'Avenia
authors.forename: Maurizio
authors.initials: M
authors.lastname: Inzirillo
authors.forename: Fabio
authors.initials: F
authors.lastname: Cattaneo
authors.forename: Domenico
authors.initials: D
authors.lastname: Cattaneo
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004106:Dilatation / Q000295:instrumentation; D004931:Esophageal Achalasia / Q000628:therapy*; D004945:Esophagoscopy; D006801:Humans
chemical_list: D065087:Acetylcholine Release Inhibitors; D001905:Botulinum Toxins