title: Management of primary achalasia: The role of endoscopy.
abstract: Achalasia is an oesophageal motor disorder which leads to the functional obstruction of the lower oesophageal sphincter (LES) and is currently incurable. The main objective of all existing therapies is to achieve a reduction in the obstruction of the distal oesophagus in order to improve oesophageal transit, relieve the symptomatology, and prevent long-term complications. The most common treatments used are pneumatic dilation (PD) and laparoscopic Heller myotomy, which involves partial fundoplication with comparable short-term success rates. The most economic non-surgical therapy is PD, with botulinum toxin injections reserved for patients with a higher surgical risk for whom the former treatment option is unsuitable. A new technology is peroral endoscopic myotomy, postulated as a possible non-invasive alternative to surgical myotomy. Other endoluminal treatments subject to research more recently include injecting ethanolamine into the LES and using a temporary self-expanding metallic stent. At present, there is not enough evidence permitting a routine recommendation of any of these three novel methods. Patients must undergo follow-up after treatment to guarantee that their symptoms are under control and to prevent complications. Most experts are in favour of some form of endoscopic follow-up, however no established guidelines exist in this respect. The prognosis for patients with achalasia is good, although a recurrence after treatment using any method requires new treatment.
authors.forename: Marisol
authors.initials: M
authors.lastname: Luján-Sanchis
authors.forename: Patricia
authors.initials: P
authors.lastname: Suárez-Callol
authors.forename: Ana
authors.initials: A
authors.lastname: Monzó-Gallego
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Bort-Pérez
authors.forename: Lydia
authors.initials: L
authors.lastname: Plana-Campos
authors.forename: Luis
authors.initials: L
authors.lastname: Ferrer-Barceló
authors.forename: Laura
authors.initials: L
authors.lastname: Sanchis-Artero
authors.forename: María
authors.initials: M
authors.lastname: Llinares-Lloret
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Tuset-Ruiz
authors.forename: Javier
authors.initials: J
authors.lastname: Sempere-Garcia-Argüelles
authors.forename: Pilar
authors.initials: P
authors.lastname: Canelles-Gamir
authors.forename: Enrique
authors.initials: E
authors.lastname: Medina-Chuliá
keywords: Achalasia; Botulinum toxin; Dilation; Endoscopic treatment; Myotomy