Skip to main content

Advertisement

SpringerLink
Log in

Updated Systematic Review of Achalasia, with a Focus on POEM Therapy

  • Review
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Aim

To systematically review clinical presentation, diagnosis, and therapy of achalasia, focusing on recent developments in high-resolution esophageal manometry (HREM) for diagnosis and peroral endoscopic myotomy (POEM) for therapy.

Methods

Systematic review of achalasia using computerized literature search via PubMed and Ovid of articles published since 2005 with keywords (“achalasia”) AND (“high resolution” or “HREM” or “peroral endoscopic myotomy” or “POEM”). Two authors independently performed literature searches and incorporated articles into this review by consensus according to prospectively determined criteria.

Results

Achalasia is an uncommon esophageal motility disorder, usually manifested by dysphagia to solids and liquids, and sometimes manifested by chest pain, regurgitation, and weight loss. Symptoms often suggest more common disorders, such as gastroesophageal reflux disease (GERD), thus often delaying diagnosis. Achalasia is a predominantly idiopathic chronic disease. Diagnosis is typically suggested by barium swallow showing esophageal dilation; absent distal esophageal peristalsis; smoothly tapered narrowing (“bird’s beak”) at esophagogastric junction; and delayed passage of contrast into stomach. Diagnostic findings at high-resolution esophageal manometry (HREM) include: distal esophageal aperistalsis and integrated relaxation pressure (trough LES pressure during 4 s) > 15 mmHg. Achalasia is classified by HREM into: type 1 classic; type 2 compartmentalized high pressure in esophageal body, and type 3 spastic. This classification impacts therapeutic decisions. Esophagogastroduodenoscopy is required before therapy to assess esophagus and esophagogastric junction and to exclude distal esophageal malignancy. POEM is a revolutionizing achalasia therapy. POEM creates a myotomy via interventional endoscopy. Numerous studies demonstrate that POEM produces comparable, if not superior, results compared to standard laparoscopic Heller myotomy (LHM), as determined by LES pressure, dysphagia frequency, Eckardt score, hospital length of stay, therapy durability, and incidence of GERD. Other therapies, including botulinum toxin injection and pneumatic dilation, have moderately less efficacy and much less durability than POEM.

Conclusion

This comprehensive review suggests that POEM is equivalent or perhaps superior to LHM for achalasia in terms of cost efficiency, hospital length of stay, and relief of dysphagia, with comparable side effects. The data are, however, not conclusive due to sparse long-term follow-up and lack of randomized comparative clinical trials. POEM therapy is currently limited by a shortage of trained endoscopists.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Harvey PR, Thomas T, Chandan JS, et al. Incidence, morbidity and mortality of patients with achalasia in England: findings from a study of nationwide hospital and primary care data. Gut. 2018. https://doi.org/10.1136/gutjnl-2018-316089.

    Article  PubMed  Google Scholar 

  2. Gennaro N, Portale G, Gallo C, et al. Esophageal achalasia in the Veneto region: epidemiology and treatment. Epidemiology and treatment of achalasia. J Gastrointest Surg. 2011;15:423–428. https://doi.org/10.1007/s11605-010-1392-7.

    Article  PubMed  Google Scholar 

  3. Sadowski DC, Ackah F, Jiang B, Svenson LW. Achalasia: incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil. 2010;22:e256–e261. https://doi.org/10.1111/j.1365-2982.2010.01511.x.

    Article  CAS  PubMed  Google Scholar 

  4. Wadhwa V, Thota PN, Parikh MP, Lopez R, Sanaka MR. Changing trends in age, gender, racial distribution and inpatient burden of achalasia. Gastroenterol Res. 2017;10:70–77. https://doi.org/10.14740/gr723w.

    Article  Google Scholar 

  5. Samo S, Carlson DA, Gregory DL, Gawel SH, Pandolfino JE, Kahrilas PJ. Incidence and prevalence of achalasia in central Chicago, 2004–2014, since the widespread use of high-resolution manometry. Clin Gastroenterol Hepatol. 2017;15:366–373. https://doi.org/10.1016/j.cgh.2016.08.030.

    Article  PubMed  Google Scholar 

  6. Evsyutina YV, Trukhmanov AS, Ivashkin VT. Family case of achalasia cardia: case report and review of literature. World J Gastroenterol. 2014;20:1114–1118. https://doi.org/10.3748/wjg.v20.i4.1114.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Romero-Hernández F, Furuzawa-Carballeda J, Hernández-Molina G, et al. Autoimmune comorbidity in achalasia patients. J Gastroenterol Hepatol. 2018;33:203–208. https://doi.org/10.1111/jgh.13839.

    Article  CAS  PubMed  Google Scholar 

  8. Kraichely RE, Farrugia G, Pittock SJ, Castell DO, Lennon V. Neural autoantibody profile of primary achalasia. Dig Dis Sci. 2010;55:307–311. https://doi.org/10.1007/s10620-009-0838-9.

    Article  PubMed  Google Scholar 

  9. Pressman A, Behar J. Etiology and pathogenesis of idiopathic achalasia. J Clin Gastroenterol. 2017;51:195–202. https://doi.org/10.1097/MCG.0000000000000780.

    Article  PubMed  Google Scholar 

  10. Facco M, Brun P, Baesso I, et al. T cells in the myenteric plexus of achalasia patients show a skewed TCR repertoire and react to HSV-1 antigens. Am J Gastroenterol. 2008;103:1598–1609. https://doi.org/10.1111/j.1572-0241.2008.01956.x.

    Article  PubMed  Google Scholar 

  11. Boeckxstaens GE. Achalasia: virus-induced euthanasia of neurons? Am J Gastroenterol. 2008;103:1610–1612. https://doi.org/10.1111/j.1572-0241.2008.01967.x.

    Article  PubMed  Google Scholar 

  12. Goldblum JR, Whyte RI, Orringer MB, Appelman HD. Achalasia. A morphologic study of 42 resected specimens. Am J Surg Path. 1994;18:327–337.

    CAS  PubMed  Google Scholar 

  13. Fei L, Rossetti G, Moccia F, et al. Definition, incidence and etiology: what’s new in the 21st century? Ann Ital Chir. 2013;84:489–494.

    PubMed  Google Scholar 

  14. Patel DA, Lappas BM, Vaezi MF. An overview of achalasia and its subtypes. Gastroenterol Hepatol (NY). 2017;13:411–421.

    Google Scholar 

  15. Eckardt VF, Hoischen T, Bernhard G. Life expectancy, complications, and causes of death in patients with achalasia: results of a 33-year follow-up investigation. Eur J Gastroenterol Hepatol. 2008;20:956–960. https://doi.org/10.1097/MEG.0b013e3282fbf5e5.

    Article  PubMed  Google Scholar 

  16. Reynolds JC, Parkman HP. Achalasia. Gastroenterol Clin North Am. 1989;18:223–255.

    CAS  PubMed  Google Scholar 

  17. Salvador R, Voltarel G, Savarino E, et al. The natural history of achalasia: evidence of a continuum-“The evolutive pattern theory”. Dig Liver Dis. 2018;50:342–347. https://doi.org/10.1016/j.dld.2017.11.012.

    Article  PubMed  Google Scholar 

  18. Vela MF, Richter JE, Khandwala F, et al. The long-term efficacy of pneumatic dilatation and Heller myotomy for the treatment of achalasia. Clin Gastroenterol Hepatol. 2006;4:580–587.

    PubMed  Google Scholar 

  19. Blam ME, Delfyett W, Levine MS, Metz DC, Katzka DA. Achalasia: a disease of varied and subtle symptoms that do not correlate with radiographic findings. Am J Gastroenterol. 2002;97:1916–1923.

    PubMed  Google Scholar 

  20. Eckardt VF. Clinical presentations and complications of achalasia. Gastrointest Clin N Am. 2001;11:281–292.

    CAS  Google Scholar 

  21. Stavropoulos SN, Friedel D, Modayil R, Parkman HP. Diagnosis and management of esophageal achalasia. Br Med J. 2016;354:2785. https://doi.org/10.1136/bmj.i12985.

    Article  Google Scholar 

  22. Shoenut JP, Micflikier AB, Yaffe CS, Den Boer B, Teskey JM. Reflux in untreated achalasia patients. J Clin Gastroenterol. 1995;20:6–11.

    CAS  PubMed  Google Scholar 

  23. Gupta M, Ghoshal UC, Jindal S, Misra A, Nath A, Saraswat VA. Respiratory dysfunction is common in patients with achalasia and improves after pneumatic dilation. Dig Dis Sci. 2014;59:744–752. https://doi.org/10.1007/s10620-013-2971-8.

    Article  CAS  PubMed  Google Scholar 

  24. Richter JE. The diagnosis and misdiagnosis of achalasia: it does not have to be so difficult. Clin Gastroenterol Hepatol. 2011;9:1010–1011. https://doi.org/10.1016/j.cgh.2011.06.012.

    Article  PubMed  Google Scholar 

  25. Niebisch S, Hadzijusufovic E, Mehdorn M, et al. Achalasia-an unnecessary long way to diagnosis. Dis Esophagus. 2017;30:1–6. https://doi.org/10.1093/dote/dow004.

    Article  CAS  PubMed  Google Scholar 

  26. Gockel I, Eckardt VF, Schmitt T, Junginger T. Pseudoachalasia: a case series and analysis of the literature. Scand J Gastroenterol. 2005;40:378–385.

    PubMed  Google Scholar 

  27. Nasa M, Bhansali S, Choudhary NS, Sud R. Uncommon cause of dysphagia: paraneoplastic achalasia. BMJ Case Rep. 2018;. https://doi.org/10.1136/bcr-2017-223929.

    Article  PubMed  Google Scholar 

  28. Neyaz Z, Gupta M, Ghoshal UC. How to perform and interpret timed barium esophagogram. J Neurogastroenterol Motil. 2013;9:251–256. https://doi.org/10.5056/jnm.2013.19.2.251.

    Article  Google Scholar 

  29. Tebaibia A, Boudjella MA, Boutarene D, Benmediouni F, Brahimi H, Oumnia N. Incidence, clinical features and para-clinical findings of achalasia in Algeria: experience of 25 years. World J Gastroenterol. 2016;22:8615–8623. https://doi.org/10.3748/wjg.v22.i38.8615.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Shiwaku H, Yamashita K, Ohmiya T, et al. New endoscopic finding of esophageal achalasia with ST Hood short type: Corona appearance. PLoS. 2018;13:e0199955. https://doi.org/10.1371/journal.pone.0199955.

    Article  CAS  Google Scholar 

  31. Jia Y, McCallum RW. Pseudoachalasia: still a tough clinical challenge. Am J Case Rep. 2015;16:768–773.

    PubMed  PubMed Central  Google Scholar 

  32. Bredenoord AJ, Fox M, Kahrilas PJ, Pandolfino JE, Schwizer W, Smout AJ. International high resolution manometry working group. Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography. Neurogastroenterol Motil. 2012;24:57–65. https://doi.org/10.1111/j.1365-2982.2011.01834.x.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology. 2008;135:1526–1533. https://doi.org/10.1053/j.gastro.2008.07.022.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Triadafilopoulos G, Clarke JO. Clinical and manometric characteristics of patients with oesophagogastric outflow obstruction: towards a new classification. BMJ Open Gastroenterol. 2017;5:e000210. https://doi.org/10.1136/bmjgast-2018-000210.

    Article  Google Scholar 

  35. Ratuapli SK, Crowell MD, DiBaise JK, et al. Opioid-induced esophageal dysfunction (OIED) in patients on chronic opioids. Am J Gastroenterol. 2015;110:979–984. https://doi.org/10.1038/ajg.2015.154.

    Article  CAS  PubMed  Google Scholar 

  36. Vicentine FP, Herbella FA, Allaix ME, Silva LC, Patti MG. Comparison of idiopathic achalasia and Chagas’ disease esophagopathy at the light of high-resolution manometry. Dis Esophagus. 2014;27:128–133. https://doi.org/10.1111/dote.12098.

    Article  CAS  PubMed  Google Scholar 

  37. Herbella FA, Oliveira DR, Del Grande JC. Are idiopathic and Chagasic achalasia two different diseases? Dig Dis Sci. 2004;49:353–360. https://doi.org/10.1023/B:DDAS.0000020486.71719.62.

    Article  PubMed  Google Scholar 

  38. Pandolfino JE, Roman S, Carlson D, et al. Distal esophageal spasm in high-resolution esophageal pressure topography: defining clinical phenotypes. Gastroenterology. 2011;141:469.

    PubMed  PubMed Central  Google Scholar 

  39. Roman S, Tutuian R. Esophageal hypertensive peristaltic disorders. Neurogastroenterol Motil. 2012;24:32.

    PubMed  Google Scholar 

  40. Carlson DA, Hirano I. Application of the functional lumen imaging probe to esophageal disorders. Curr Treat Options Gastroenterol. 2017;15:10–25. https://doi.org/10.1007/s11938-017-0116-4.

    Article  PubMed  Google Scholar 

  41. Ahuja NK, Agnihotri A, Lynch KL, et al. Esophageal distensibility measurement: impact on clinical management and procedure length. Dis Esophagus. 2017;30:1–8. https://doi.org/10.1093/dote/dox038.

    Article  CAS  PubMed  Google Scholar 

  42. Rohof WO, Hirsch DP, Kessing BF, Boeckxstaens GE. Efficacy of treatment for patients with achalasia depends on the distensibility of the esophagogastric junction. Gastroenterology. 2012;143:328–335. https://doi.org/10.1053/j.gastro.2012.04.048.

    Article  PubMed  Google Scholar 

  43. Ngamruengphong S, von Rahden BH, Filser J, et al. Intraoperative measurement of esophagogastric junction cross-sectional area by impedance planimetry correlates with clinical outcomes of peroral endoscopic myotomy for achalasia: a multicenter study. Surg Endosc. 2016;30:2886–2894. https://doi.org/10.1007/s00464-015-4574-2.

    Article  PubMed  Google Scholar 

  44. Hirano I, Pandolfino JE, Boeckxstaens GE. Functional lumen imaging probe for the management of esophageal disorders: expert review from the clinical practice updates committee of the AGA institute. Clin Gastroenterol Hepatol. 2017;15:325–334. https://doi.org/10.1016/j.cgh.2016.10.022.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Pardoe EM. Development of a multistage diet for dysphagia. J Am Diet Assoc. 1993;93:568–571.

    CAS  PubMed  Google Scholar 

  46. Dughera L, Chiaverina M, Cacciotella L, Cisarò F. Management of achalasia. Clin Exp Gastroenterol. 2011;4:33–41. https://doi.org/10.2147/CEG.S11593.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Gelfond M, Rozen P, Gilat T. Isosorbide dinitrate and nifedipine treatment of achalasia: a clinical, manometric and radionuclide evaluation. Gastroenterology. 1982;83:963–969.

    CAS  PubMed  Google Scholar 

  48. Wong RK, Maydonovitch C, Garcia JE, Johnson LF, Castell DO. The effect of terbutaline sulfate, nitroglycerin, and aminophylline on lower esophageal sphincter pressure and radionuclide esophageal emptying in patients with achalasia. J Clin Gastroenterol. 1987;9:386–389.

    CAS  PubMed  Google Scholar 

  49. Penagini R, Bartesaghi B, Negri G, Bianchi PA. Effect of loperamide on lower oesophageal sphincter pressure in idiopathic achalasia. Scand J Gastroenterol. 1994;29:1057–1060.

    CAS  PubMed  Google Scholar 

  50. Bortolotti M, Mari C, Lopilato C, Porrazzo G, Miglioli M. Effects of sildenafil on esophageal motility of patients with idiopathic achalasia. Gastroenterology. 2000;118:253–257.

    CAS  PubMed  Google Scholar 

  51. Marzio L, Grossi L, DeLaurentiis MF, Cennamo L, Lapenna D, Cuccurullo F. Effect of cimetropium bromide on esophageal motility and transit in patients affected by primary achalasia. Dig Dis Sci. 1994;39:1389–1394. https://doi.org/10.1007/BF02088038.

    Article  CAS  PubMed  Google Scholar 

  52. Enestvedt BK, Williams JL, Sonnenberg A. Epidemiology and practice patterns of achalasia in a large multi-centre database. Aliment Pharmacol Ther. 2011;33:1209–1214. https://doi.org/10.1111/j.1365-2036.2011.04655.x.

    Article  CAS  PubMed  Google Scholar 

  53. Nassri A, Ramzan Z. Pharmacotherapy for the management of achalasia: current status, challenges and future directions. World J Gastrointest Pharmacol Ther. 2015;6:145–155. https://doi.org/10.4292/wjgpt.v6.i4.145.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Pasricha PJ, Rai R, Ravich WJ, Hendrix TR, Kalloo AN. Botulinum toxin for achalasia: long-term outcome and predictors of response. Gastroenterology. 1996;110:1410–1415.

    CAS  PubMed  Google Scholar 

  55. Annese V, Bassotti G, Coccia G, et al. A multicentre randomised study of intrasphincteric botulinum toxin in patients with oesophageal achalasia. GISMAD Achalasia Study Group. Gut. 2000;46:597–600.

    CAS  PubMed  PubMed Central  Google Scholar 

  56. Campos GM, Vittinghoff E, Rabl C, et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg. 2009;249:45–57. https://doi.org/10.1097/SLA.0b013e31818e43ab.

    Article  PubMed  Google Scholar 

  57. Mikaeli J, Bishehsari F, Montazeri G, et al. Injection of botulinum toxin before pneumatic dilatation in achalasia treatment: a randomized-controlled trial. Alim Pharmacol Ther. 2006;24:983–989. https://doi.org/10.1111/j.1365-2036.2006.03083.x.

    Article  CAS  Google Scholar 

  58. Smith CD, Stival A, Howell DL, Swafford V. Endoscopic therapy for achalasia before Heller myotomy results in worse outcomes than Heller myotomy alone. Ann Surg. 2006;243:579–584. https://doi.org/10.1097/01.sla.0000217524.75529.2d.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Carter JT, Nguyen D, Roll GR, Ma SW, Wang LW. Predictors of long-term outcome after laparoscopic esophagomyotomy and Dor fundoplication for achalasia. Arch Surg. 2011;146:1024–1028. https://doi.org/10.1001/archsurg.2011.214.

    Article  PubMed  Google Scholar 

  60. Orenstein SB, Raigani S, Wu YV, et al. Peroral endoscopic myotomy (POEM) leads to similar results in patients with and without prior endoscopic or surgical therapy. Surg Endosc. 2015;29:1064–1070. https://doi.org/10.1007/s00464-014-3782-5.

    Article  PubMed  Google Scholar 

  61. van Hoeij FB, Tack JF, Pandolfino JE, et al. Complications of botulinum toxin injections for treatment of esophageal motility disorders. Dis Esophagus. 2017;30:1–5. https://doi.org/10.1111/dote.12491.

    Article  PubMed  Google Scholar 

  62. Omprakash HM, Rajendran SC. Botulinum toxin deaths: What is the fact? J Cutan Aesthet Surg. 2008;1:95–97. https://doi.org/10.4103/0974-2077.44169.

    Article  PubMed Central  Google Scholar 

  63. Rosenweig NR, Cocco AE. Treatment of a sigmoid esophagus in achalasia by pneumatic dilatation. Gastrointest Endosc. 1966;13:15–16.

    CAS  PubMed  Google Scholar 

  64. Markar S, Zaninotto G. Endoscopic pneumatic dilation for esophageal achalasia. Am Surg. 2018;84:473–476.

    PubMed  Google Scholar 

  65. Chuah SK, Wu KL, Hu TH, Tai WC, Changchien CS. Endoscope-guided pneumatic dilation for treatment of esophageal achalasia. World J Gastroenterol. 2010;16:411–417. https://doi.org/10.3748/wjg.v16.i4.411.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Farhoomand K, Connor JT, Richter JE, Achkar E, Vaezi MF. Predictors of outcome of pneumatic dilation in achalasia. Clin Gastroenterol Hepatol. 2004;2:389–394.

    PubMed  Google Scholar 

  67. Lynch KL, Pandolfino JE, Howden CW, Kahrilas PJ. Major complications of pneumatic dilation and Heller myotomy for achalasia: single-center experience and systematic review of the literature. Am J Gastroenterol. 2012;107:1817–1825. https://doi.org/10.1038/ajg.2012.332.

    Article  PubMed  Google Scholar 

  68. O’Dea J, Siersema PD. Esophageal dilation with integrated balloon imaging: initial evaluation in a porcine model. Therap Adv Gastroenterol. 2013;6:109–114. https://doi.org/10.1177/1756283X12467566.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Zerbib F, Thétiot V, Richy F, Benajah DA, Message L, Lamouliatte H. Repeated pneumatic dilations as long-term maintenance therapy for esophageal achalasia. Am J Gastroenterol. 2006;101:692–697. https://doi.org/10.1111/j.1572-0241.2006.00385.x.

    Article  PubMed  Google Scholar 

  70. Campos GM, Vittinghoff E, Rabl C, et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg. 2009;249:45–57. https://doi.org/10.1097/SLA.0b013e31818e43ab.

    Article  PubMed  Google Scholar 

  71. Abid S, Champion G, Richter JE, McElvein R, Slaughter RL, Koehler RE. Treatment of achalasia: the best of both worlds. Am J Gastroenterol. 1994;89:979–985.

    CAS  PubMed  Google Scholar 

  72. Chan KC, Wong SK, Lee DW, et al. Short-term and long-term results of endoscopic balloon dilation for achalasia: 12 years’ experience. Endoscopy. 2004;36:690–694.

    CAS  PubMed  Google Scholar 

  73. Dobrucali A, Erzin Y, Tuncer M, Dirican A. Long-term results of graded pneumatic dilatation under endoscopic guidance in patients with primary esophageal achalasia. World J Gastroenterol. 2004;10:3322–3327.

    PubMed  PubMed Central  Google Scholar 

  74. Guardino JM, Vela MF, Connor JT, Richter JE. Pneumatic dilation for the treatment of achalasia in untreated patients and patients with failed Heller myotomy. J Clin Gastroenterol. 2004;38:855–860.

    PubMed  Google Scholar 

  75. Wehrmann T, Jacobi V, Jung M, Lembcke B, Caspary WF. Pneumatic dilation in achalasia with a low-compliance balloon: results of a 5-year prospective evaluation. Gastrointest Endosc. 1995;42:31–36.

    CAS  PubMed  Google Scholar 

  76. Mikaeli J, Bishehsari F, Montazeri G, Yaghoobi M, Malekzadeh R. Pneumatic balloon dilatation in achalasia: a prospective comparison of safety and efficacy with different balloon diameters. Aliment Pharmacol Ther. 2004;20:431–436. https://doi.org/10.1111/j.1365-2036.200402080.x.

    Article  CAS  PubMed  Google Scholar 

  77. Rosemurgy A, Downs D, Jadick G, et al. Dissatisfaction after laparoscopic Heller myotomy: the truth is easy to swallow. Am J Surg. 2017;213:1091–1097. https://doi.org/10.1016/j.amjsurg.2017.03.043.

    Article  PubMed  Google Scholar 

  78. Schlottmann F, Andolfi C, Kavitt RT, Konda VJA, Patti MG. Multidisciplinary approach to esophageal achalasia: a single center experience. J Laparoendosc Adv Surg Tech A. 2017;27:358–362. https://doi.org/10.1089/lap.2016.0594.

    Article  PubMed  Google Scholar 

  79. Smith CD, Stival A, Howell DL, Swafford V. Endoscopic therapy for achalasia before Heller myotomy results in worse outcomes than Heller myotomy alone. Ann Surg.. 2006;243:579–584. https://doi.org/10.1097/01.sla.0000217524.75529.2d. (discussion 584–586).

    Article  PubMed  PubMed Central  Google Scholar 

  80. Patti MG, Arcerito M, De Pinto M, et al. Comparison of thoracoscopic and laparoscopic Heller myotomy for achalasia. J Gastrointest Surg. 1998;2:561–566.

    CAS  PubMed  Google Scholar 

  81. Torquati A, Richards WO, Holzman MD, Sharp KW. Laparoscopic myotomy for achalasia: predictors of successful outcome after 200 cases. Ann Surg. 2006;243:587–591.

    PubMed  PubMed Central  Google Scholar 

  82. Novais PA, Lemme EM. 24-h pH monitoring patterns and clinical response after achalasia treatment with pneumatic dilation or laparoscopic Heller myotomy. Aliment Pharmacol Ther. 2010;32:1257–1265. https://doi.org/10.1111/j.1365-2036.2010.04461.x.

    Article  CAS  PubMed  Google Scholar 

  83. Rebecchi F, Allaix ME, Schlottmann F, Patti MG, Morino M. Laparoscopic Heller myotomy and fundoplication: What is the evidence? Am Surg. 2018;84:481–488.

    PubMed  Google Scholar 

  84. Torres-Villalobos G, Coss-Adame E, Furuzawa-Carballeda J, et al. Dor vs Toupet fundoplication after laparoscopic Heller myotomy: long-term randomized controlled trial evaluated by high-resolution manometry. J Gastrointest Surg. 2018;22:13–22. https://doi.org/10.1007/s11605-017-3578-8.

    Article  PubMed  Google Scholar 

  85. Rebecchi F, Giaccone C, Farinella E, Campaci R, Morino M. Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia: long-term results. Am Surg. 2008;248:1023–1030. https://doi.org/10.1097/SLA.0b013e318190a776.

    Article  Google Scholar 

  86. Kummerow Broman K, Phillips SE, Faqih A, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: long-term symptomatic follow-up of a prospective randomized controlled trial. Surg Endosc. 2018;32:1668–1674. https://doi.org/10.1007/s00464-017-5845-x.

    Article  PubMed  Google Scholar 

  87. Fernandez-Ananin S, Fernández AF, Balagué C, Sacoto D, Targarona EM. What to do when Heller’s myotomy fails? Pneumatic dilatation, laparoscopic remyotomy or peroral endoscopic myotomy: a systematic review. J Minim Access Surg. 2018;14:177–184. https://doi.org/10.4103/jmas.JMAS_94_17.

    Article  PubMed  PubMed Central  Google Scholar 

  88. Teitelbaum EN, Soper NJ, Pandolfino JE, et al. An extended proximal esophageal myotomy is necessary to normalize EGJ distensibility during Heller myotomy for achalasia, but not POEM. Surg Endosc. 2014;28:2840–2847. https://doi.org/10.1007/s00464-014-3563-1.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Barbieri LA, Bona D, Aiolfi A, et al. Minimally-invasive myotomy: percutaneous laparoscopic surgical approach for achalasia. Surg Technol Int. 2017;31:101–104.

    PubMed  Google Scholar 

  90. Kim SS, Guillen-Rodriguez J, Little AG. Optimal surgical intervention for achalasia: laparoscopic or robotic approach. J Robot Surg. 2019;13:397–400. https://doi.org/10.1007/s11701-018-0865-7.

    Article  PubMed  Google Scholar 

  91. Ortega JA, Madureri V, Perez L. Endoscopic myotomy in the treatment of achalasia. Gastrointest Endosc. 1980;26:8–10.

    CAS  PubMed  Google Scholar 

  92. Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42:265–271. https://doi.org/10.1055/s-0029-1244080.

    Article  CAS  PubMed  Google Scholar 

  93. Fritscher-Ravens A, Patel K, Ghanbari A, et al. Natural orifice transluminal endoscopic surgery (NOTES) in the mediastinum: long-term survival animal experiments in transesophageal access, including minor surgical procedures. Endoscopy. 2007;39:870–875.

    CAS  PubMed  Google Scholar 

  94. Pasricha PJ, Hawari R, Ahmed I, et al. Submucosal endoscopic esophageal myotomy: a novel experimental approach for the treatment of achalasia. Endoscopy. 2007;39:761–764.

    CAS  PubMed  Google Scholar 

  95. Ren Z, Zhong Y, Zhou P, et al. Perioperative management and treatment for complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA) (data from 119 cases). Surg Endosc. 2012;26:3267–3672. https://doi.org/10.1007/s00464-012-2336-y.

    Article  PubMed  Google Scholar 

  96. Kane ED, Budhraja V, Desilets DJ, Romanelli JR. Myotomy length informed by high-resolution esophageal manometry (HREM) results in improved per-oral endoscopic myotomy (POEM) outcomes for type III achalasia. Surg Endosc. 2019;33:886–894. https://doi.org/10.1007/s00464-018-6356-0.

    PubMed  Google Scholar 

  97. Wang J, Tan N, Xiao Y, et al. Safety and efficacy of the modified peroral endoscopic myotomy with shorter myotomy for achalasia patients: a prospective study. Dis Esophagus. 2015;28:720–727. https://doi.org/10.1111/dote.12280.

    Article  CAS  PubMed  Google Scholar 

  98. Tanaka S, Kawara F, Toyonaga T, et al. Two penetrating vessels as a novel indicator of the appropriate distal end of peroral endoscopic myotomy. Dig Endosc. 2018;30:206–211. https://doi.org/10.1111/den.12957.

    Article  PubMed  Google Scholar 

  99. Friedel D, Modayil R, Iqbal S, Grendell JH, Stavropoulos SN. Per-oral endoscopic myotomy for achalasia: an American perspective. World J Gastrointest Endosc. 2013;5:420–427. https://doi.org/10.4253/wjge.v5.i9.420.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Grimes KL, Inoue H, Onimaru M, et al. Double-scope per oral endoscopic myotomy (POEM): a prospective randomized controlled trial. Surg Endosc. 2016;30:1344–1351. https://doi.org/10.1007/s00464-015-4396-2.

    Article  PubMed  Google Scholar 

  101. Kumbhari V, Besharati S, Abdelgelil A, et al. Intraprocedural fluoroscopy to determine the extent of the cardiomyotomy during per-oral endoscopic myotomy (with video). Gastrointest Endosc. 2015;81:1451–1456. https://doi.org/10.1016/j.gie.2015.01.052.

    Article  PubMed  Google Scholar 

  102. Pescarus R, Shlomovitz E, Sharata AM, et al. Endoscopic suturing versus endoscopic clip closure of the mucosotomy during a per-oral endoscopic myotomy (POEM): a case-control study. Surg Endosc. 2016;30:2132–2135. https://doi.org/10.1007/s00464-015-4464-7.

    Article  PubMed  Google Scholar 

  103. Grimes KL, Inoue H. Per oral endoscopic myotomy for achalasia: a detailed description of the technique and review of the literature. Thoracic Surg Clin. 2016;26:147–162. https://doi.org/10.1016/j.thorsurg.2015.12.003.

    Article  Google Scholar 

  104. Ponsky JL, Marks JM, Orenstein SB. Retrograde myotomy: a variation in per oral endoscopic myotomy (POEM) technique. Surg Endosc. 2014;28:3257–3259. https://doi.org/10.1007/s00464-014-3568-9.

    Article  PubMed  Google Scholar 

  105. Ramchandani M, Nabi Z, Reddy DN, et al. Outcomes of anterior myotomy versus posterior myotomy during POEM: a randomized pilot study. Endosc Int Open. 2018;6:E190–E198. https://doi.org/10.1055/s-0043-121877.

    Article  PubMed  PubMed Central  Google Scholar 

  106. Tan Y, Lv L, Wang X, et al. Efficacy of anterior versus posterior per-oral endoscopic myotomy for treating achalasia: a randomized, prospective study. Gastrointest Endosc. 2018;88:46–54. https://doi.org/10.1016/j.gie.2018.03.009.

    Article  PubMed  Google Scholar 

  107. Tang X, Gong W, Deng Z, et al. Comparison of conventional versus Hybrid knife peroral endoscopic myotomy methods for esophageal achalasia: a case-control study. Scand J Gastroenterol. 2016;51:494–500. https://doi.org/10.3109/00365521.2015.1059878.

    Article  PubMed  Google Scholar 

  108. Liu J, Jiao Y, Niu Y, Yu L, Ji M, Zhang S. Preliminary study of 1940 nm thulium laser usage in peroral endoscopic myotomy for achalasia. Dis Esoph. 2018;31:132. https://doi.org/10.1093/dote/dox132.

    Article  Google Scholar 

  109. Duan T, Tan Y, Zhou J, Lv L, Liu D. A retrospective study of peroral endoscopic full-thickness myotomy in patients with severe achalasia. J Laparoendosc Surg Tech. 2017;27:770–776. https://doi.org/10.1089/lap.2016.0445.

    Article  Google Scholar 

  110. Ngamruengphong S, von Rahden BH, Filser J, et al. Intraoperative measurement of esophagogastric junction cross-sectional area by impedance planimetry correlates with clinical outcomes of peroral endoscopic myotomy for achalasia: a multicenter study. Surg Endosc. 2016;30:2886–2894. https://doi.org/10.1007/s00464-015-4574-2.

    Article  PubMed  Google Scholar 

  111. Stavropoulos SN, Modayil RJ, Friedel D, Savides T. The international per oral endoscopic myotomy survey (IPOEMS): a snapshot of the global POEM experience. Surg Endosc. 2013;27:3322–3338. https://doi.org/10.1007/s00464-013-2913-8.

    Article  PubMed  Google Scholar 

  112. Inoue H, Sato H, Ikeda H, et al. Per-oral endoscopic myotomy: a series of 500 patients. J Am Coll Surg. 2015;221:256–264. https://doi.org/10.1016/j.jamcollsurg.2015.03.057.

    Article  PubMed  Google Scholar 

  113. Bechara R, Onimaru M, Ikeda H, Inoue H. Per-oral endoscopic myotomy, 1000 cases later: pearls, pitfalls, and practical considerations. Gastrointest Endosc. 2016;84:330–338. https://doi.org/10.1016/j.gie.2016.03.1469.

    Article  PubMed  Google Scholar 

  114. Ramchandani M, Nageshwar Reddy D, Darisetty S, et al. Peroral endoscopic myotomy for achalasia cardia: treatment analysis and follow up of over 200 consecutive patients at a single center. Dis Endosc. 2016;28:19–26. https://doi.org/10.1111/den.12495.

    Article  Google Scholar 

  115. Ling TS, Guo HM, Yang T, Peng CY, Zou XP, Shi RH. Effectiveness of peroral endoscopic myotomy in the treatment of achalasia: a pilot trial in Chinese Han population with a minimum of one-year follow-up. J Dig Dis. 2014;15:352–358. https://doi.org/10.1111/1751-2980.12153.

    Article  PubMed  Google Scholar 

  116. Benedict JJ, Golas AA, Richter JE, Velanovich V. Health-related quality of life and physiological outcomes of peroral endoscopic myotomy for achalasia. J Laparoendosc Adv Surg Tech. 2017;27:778–783. https://doi.org/10.1089/lap.2017.0087.

    Article  Google Scholar 

  117. Teitelbaum EN, Soper NJ, Santos BF, et al. Symptomatic and physiologic outcomes one year after peroral esophageal myotomy (POEM) for treatment of achalasia. Surg Endosc. 2014;28:3359–3365. https://doi.org/10.1007/s00464-014-3628-1.

    Article  PubMed  Google Scholar 

  118. Tang Y, Xie C, Wang M, Jiang L, Shi R, Lin L. Association of high-resolution manometry metrics with the symptoms of achalasia and the symptomatic outcomes of peroral esophageal myotomy. PLOS One. 2015;30:e0139385. https://doi.org/10.1371/journal.pone.0139385.

    Article  CAS  Google Scholar 

  119. Kumbhari V, Tieu AH, Onimaru M, et al. Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of type III achalasia in 75 patients: a multicenter comparative study. Endosc Int Open. 2015;3:E195–E201. https://doi.org/10.1055/s-0034-1391668.

    Article  PubMed  PubMed Central  Google Scholar 

  120. Li C, Tan Y, Wang X, Liu D. Peroral endoscopic myotomy for treatment of achalasia in children and adolescents. J Pediatric Surg. 2015;50:201–205. https://doi.org/10.1016/j.jpedsurg.2014.10.017.

    Article  Google Scholar 

  121. Li CJ, Tan YY, Wang XH, Liu DL. Peroral endoscopic myotomy for achalasia in patients aged ≥ 65 years. World J Gastroenterol. 2015;21:9175–9181. https://doi.org/10.3748/wjg.v21.i30.9175.

    Article  PubMed  PubMed Central  Google Scholar 

  122. Crespin OM, Liu LWC, Parmar A, et al. Safety and efficacy of POEM for treatment of achalasia: a systematic review of the literature. Surg Endosc. 2017;31:2187–2201. https://doi.org/10.1007/s00464-016-5217-y.

    Article  PubMed  Google Scholar 

  123. Patel K, Abbassi-Ghadi N, Markar S, Kumar S, Jethwa P, Zaninotto G. Peroral endoscopic myotomy for the treatment of esophageal achalasia: systematic review and pooled analysis. Dis Esoph. 2016;29:807–819. https://doi.org/10.1111/dote.12387.

    Article  CAS  Google Scholar 

  124. Akintoye E, Kumar N, Obaitan I, Alayo QA, Thompson CC. Peroral endoscopic myotomy: a meta-analysis. Endoscopy. 2016;48:1059–1068. https://doi.org/10.1055/s-0042-114426.

    Article  PubMed  Google Scholar 

  125. Martinek J, Svecova H, Vackova Z, et al. Per-oral endoscopic myotomy (POEM): mid-term efficacy and safety. Surg Endosc. 2018;32:1293–1302. https://doi.org/10.1007/s00464-017-5807-3.

    Article  PubMed  Google Scholar 

  126. Pannu D, Yang D, Abbitt PL, Draganov PV. Prospective evaluation of CT esophagram findings after peroral endoscopic myotomy. Gastrointest Endosc. 2016;84:408–415. https://doi.org/10.1016/j.gie.2016.02.022.

    Article  PubMed  Google Scholar 

  127. Yang S, Zeng MS, Zhang ZY, Zhang HL, Liang L, Zhang XW. Pneumomediastinum and pneumoperitoneum on computed tomography after peroral endoscopic myotomy (POEM): postoperative changes or complications? Acta Radiol. 2015;56:1216–1221. https://doi.org/10.1177/0284185114551399.

    Article  PubMed  Google Scholar 

  128. Jayan N, Jacob JS, Mathew M, Mukkada RJ. Anesthesia for peroral endoscopic myotomy: a retrospective case series. J Anaesthesiol Clin Pharmacol. 2016;32:379–381. https://doi.org/10.4103/0970-9185.188829.

    Article  PubMed  PubMed Central  Google Scholar 

  129. Cai MY, Zhou PH, Yao LQ, Zhu BQ, Liang L, Li QL. Thoracic CT after peroral endoscopic myotomy for the treatment of achalasia. Gastrointest Endosc. 2014;80:1046–1055. https://doi.org/10.1016/j.gie.2014.05.004.

    Article  PubMed  Google Scholar 

  130. Wang X, Tan Y, Zhang J, Liu D. Risk factors for gas-related complications of peroral endoscopic myotomy in achalasia. Neth J Med. 2015;73:76–81.

    CAS  PubMed  Google Scholar 

  131. Haito-Chavez Y, Inoue H, Beard KW, et al. Comprehensive analysis of adverse events associated with per oral endoscopic myotomy in 1826 patients: an international multicenter study. Am J Gastroenterol. 2017;112:1267–1276. https://doi.org/10.1038/ajg.2017.139.

    Article  PubMed  Google Scholar 

  132. Teitelbaum EN, Soper NJ, Arafat FO, et al. Analysis of a learning curve and predictors of intraoperative difficulty for peroral esophageal myotomy (POEM). J Gastrointest Surg. 2014;18:92–98. https://doi.org/10.1007/s11605-013-2332-0.

    Article  PubMed  Google Scholar 

  133. Kurian AA, Dunst CM, Sharata A, Bhayani NH, Reavis KM, Swanström LL. Peroral endoscopic esophageal myotomy: defining the learning curve. Gastrointest Endosc. 2013;77:719–725. https://doi.org/10.1016/j.gie.2012.12.006.

    Article  PubMed  Google Scholar 

  134. Patel KS, Calixte R, Modayil RJ, Friedel D, Brathwaite CE, Stavropoulos SN. The light at the end of the tunnel: a single-operator learning curve analysis for per oral endoscopic myotomy. Gastrointest Endosc. 2015;81:1181–1187. https://doi.org/10.1016/j.gie.2014.10.002.

    Article  PubMed  Google Scholar 

  135. Hungness ES, Sternbach JM, Teitelbaum EN, Kahrilas PJ, Pandolfino JE, Soper NJ. Per-oral endoscopic myotomy (POEM) after the learning curve: durable long-term results with a low complication rate. Ann Surg. 2016;264:508–517. https://doi.org/10.1097/SLA.0000000000001870.

    Article  PubMed  Google Scholar 

  136. Khashab MA, El Zein M, Kumbhari V, et al. Comprehensive analysis of efficacy and safety of peroral endoscopic myotomy performed by a gastroenterologist in the endoscopy unit: a single-center experience. Gastrointest Endosc. 2016;83:117–125. https://doi.org/10.1016/j.gie.2015.06.013.

    Article  PubMed  Google Scholar 

  137. NOSCAR POEM White Paper Committee, Stavropoulos SN, Desilets DJ, et al. Per-oral endoscopic myotomy white paper summary. Gastrointest Endosc. 2014;80:1–15. https://doi.org/10.1016/j.gie.2014.04.014.

    Article  Google Scholar 

  138. Bhayani NH, Kurian AA, Dunst CM, Sharata AM, Rieder E, Swanstrom LL. A comparative study on comprehensive, objective outcomes of laparoscopic Heller myotomy with per-oral endoscopic myotomy (POEM) for achalasia. Ann Surg. 2014;259:1098–1103. https://doi.org/10.1097/SLA.0000000000000268.

    Article  PubMed  Google Scholar 

  139. Shiwaku H, Inoue H, Sasaki T, et al. A prospective analysis of GERD after POEM on anterior myotomy. Surg Endosc. 2016;30:2496–2504. https://doi.org/10.1007/s00464-015-4507-0.

    Article  PubMed  Google Scholar 

  140. Guelrud M, Rossiter A, Souney PF, Sulbaran M. Transcutaneous electrical nerve stimulation decreases lower esophageal sphincter pressure in patients with achalasia. Dig Dis Sci. 1991;36:1029–1033. https://doi.org/10.1007/BF01297442.

    Article  CAS  PubMed  Google Scholar 

  141. Mikaeli J, Veisari AK, Fazlollahi N, et al. Ethanolamine oleate versus botulinum toxin in the treatment of idiopathic achalasia. Ann Gastroenterol. 2015;28:229–235.

    PubMed  PubMed Central  Google Scholar 

  142. Moretó M, Ojembarrena E, Barturen A, Casado I. Treatment of achalasia by injection of sclerosant substances: a long-term report. Dig Dis Sci. 2013;58:788–796. https://doi.org/10.1007/s10620-012-2476-x.

    Article  PubMed  Google Scholar 

  143. Zhao JG, Li YD, Cheng YS, et al. Long-term safety and outcome of a temporary self-expanding metallic stent for achalasia: a prospective study with a 13-year single-center experience. Eur Radiol. 2009;19:1973–1980. https://doi.org/10.1007/s00330-009-1373-y.

    Article  PubMed  PubMed Central  Google Scholar 

  144. Zeng Y, Dai YM, Wan XJ. Clinical remission following endoscopic placement of retrievable, fully covered metal stents in patients with esophageal achalasia. Dis Esophagus. 2014;27:103–108. https://doi.org/10.1111/dote.12083.

    Article  CAS  PubMed  Google Scholar 

  145. Cheng YS, Ma F, Li YD, et al. Temporary self-expanding metallic stents for achalasia: a prospective study with a long-term follow-up. World J Gastroenterol. 2010;16:5111–5117.

    PubMed  PubMed Central  Google Scholar 

  146. Al Taii H, Confer B, Gabbard S, et al. Endoscopic management of an intramural sinus leak after per-oral endoscopic myotomy. ACG Case Rep J. 2016;3:e158. https://doi.org/10.14309/crj.2016.131.

    Article  PubMed  PubMed Central  Google Scholar 

  147. Zaninotto G, Bennett C, Boeckxstaens G, et al. The 2018 ISDE achalasia guidelines. Dis Esophagus. 2018;31:71. https://doi.org/10.1093/dote/doy071.

    Article  Google Scholar 

  148. Leyden JE, Moss AC, MacMathuna P. Endoscopic pneumatic dilation versus botulinum toxin injection in the management of primary achalasia. Cochrane Database Syst Rev. 2014;12:CD005046. https://doi.org/10.1002/14651858.cd005046.pub3.

    Article  Google Scholar 

  149. Bakhshipour A, Rabbani R, Shirani S, Soleimani HA, Mikaeli J. Comparison of pneumatic dilation with pneumatic dilation plus botulinum toxin for treatment of achalasia. Acta Med Iran. 2010;48:107–110.

    PubMed  Google Scholar 

  150. Bansal R, Nostrant TT, Scheiman JM, et al. Intrasphincteric botulinum toxin versus pneumatic balloon dilation for treatment of primary achalasia. J Clin Gastroenterol. 2003;36:209–214. https://doi.org/10.1097/00004836-200303000-00005.

    Article  CAS  PubMed  Google Scholar 

  151. Ghoshal UC, Chaudhuri S, Pal BB, Dhar K, Ray G, Banerjee PK. Randomized controlled trial of intrasphincteric botulinum toxin A injection versus balloon dilatation in treatment of achalasia cardia. Dis Esophagus. 2001;14:227–231. https://doi.org/10.1046/j.1442-2050.2001.00189.x.

    Article  CAS  PubMed  Google Scholar 

  152. Mikaeli J, Farrokhi F, Bishehsari F, Mahdavinia M, Malekzadeh R. Gender effect on clinical features of achalasia: a prospective study. BMC Gastroenterol. 2006;6:12. https://doi.org/10.1186/1471-230X-6-12.

    Article  PubMed  PubMed Central  Google Scholar 

  153. Vaezi MF, Richter JE, Wilcox CM, et al. Botulinum toxin versus pneumatic dilatation in the treatment of achalasia: a randomised trial. Gut. 1999;44:231–239.

    CAS  PubMed  PubMed Central  Google Scholar 

  154. Andrews CN, Anvari M, Dobranowski J. Laparoscopic Heller’s myotomy or botulinum toxin injection for management of esophageal achalasia. Patient choice and treatment outcomes. Surg Endosc. 1999;13:742–746.

    CAS  PubMed  Google Scholar 

  155. Zaninotto G, Annese V, Costantini M, et al. Randomized controlled trial of botulinum toxin versus laparoscopic Heller myotomy for esophageal achalasia. Ann Surg. 2004;239:364–370.

    PubMed  PubMed Central  Google Scholar 

  156. Boeckxstaens GE, Annese V, des Varannes SB, et al. European achalasia trial investigators. Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med. 2011;364:1807–1816. https://doi.org/10.1056/nejmoa1010502.

    Article  CAS  PubMed  Google Scholar 

  157. Moonen A, Annese V, Belmans A, et al. Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut. 2016;65:32–39. https://doi.org/10.1136/gutjnl-2015-310602.

    Article  Google Scholar 

  158. Karanicolas PJ, Smith SE, Inculet RI, et al. The cost of laparoscopic myotomy versus pneumatic dilatation for esophageal achalasia. Surg Endosc. 2007;21:1198–1206. https://doi.org/10.1007/s00464-007-9364-z.

    Article  PubMed  Google Scholar 

  159. Kostic S, Kjellin A, Ruth M, et al. Pneumatic dilatation or laparoscopic cardiomyotomy in the management of newly diagnosed idiopathic achalasia. Results of a randomized controlled trial. World J Surg. 2007;31:470–478. https://doi.org/10.1007/s00268-006-0600-9.

    Article  CAS  PubMed  Google Scholar 

  160. Persson J, Johnsson E, Kostic S, Lundell L, Smedh U. Treatment of achalasia with laparoscopic myotomy or pneumatic dilatation: long-term results of a prospective, randomized study. World J Surg. 2015;39:713–720. https://doi.org/10.1007/s00268-014-2869-4.

    Article  PubMed  Google Scholar 

  161. Wang X, Tan Y, Lv L, et al. Peroral endoscopic myotomy versus pneumatic dilation for achalasia in patients aged ≥ 65 years. Rev Esp Enferm Dig. 2016;108:637–641. https://doi.org/10.17235/reed.2016.4488/2016.

    Article  PubMed  Google Scholar 

  162. Docimo S Jr, Mathew A, Shope AJ, Winder JS, Haluck RS, Pauli EM. Reduced postoperative pain scores and narcotic use favor per-oral endoscopic myotomy over laparoscopic Heller myotomy. Surg Endosc. 2017;31:795–800. https://doi.org/10.1007/s00464-016-5034-3.

    Article  PubMed  Google Scholar 

  163. Sanaka MR, Hayat U, Thota PN, et al. Efficacy of peroral endoscopic myotomy vs other achalasia treatments in improving esophageal function. World J Gastroenterol. 2016;22:4918–4925. https://doi.org/10.3748/wjg.v22.i20.4918.

    Article  PubMed  PubMed Central  Google Scholar 

  164. Schlottmann F, Luckett DJ, Fine J, Shaheen NJ, Patti MG. Laparoscopic Heller myotomy versus peroral endoscopic myotomy (POEM) for achalasia: a systematic review and meta-analysis. Ann Surg. 2018;267:451–460. https://doi.org/10.1097/SLA.0000000000002311.

    Article  PubMed  Google Scholar 

  165. Zhang Y, Wang H, Chen X, et al. Per-oral endoscopic myotomy versus laparoscopic Heller myotomy for achalasia: a meta-analysis of nonrandomized comparative studies. Medicine (Baltimore). 2016;95:e2736. https://doi.org/10.1097/MD.0000000000002736.

    Article  Google Scholar 

  166. Schneider AM, Louie BE, Warren HF, Farivar AS, Schembre DB, Aye RW. A matched comparison of per oral endoscopic myotomy to laparoscopic Heller myotomy in the treatment of achalasia. J Gastrointest Surg. 2016;20:1789–1796. https://doi.org/10.1007/s11605-016-3232-x.

    Article  PubMed  Google Scholar 

  167. Marano L, Pallabazzer G, Solito B, et al. Surgery or peroral esophageal myotomy for achalasia: a systematic review and meta-analysis. Medicine (Baltimore). 2016;95:e3001. https://doi.org/10.1097/MD.0000000000003001.

    Article  Google Scholar 

  168. Talukdar R, Inoue H, Nageshwar Reddy D. Efficacy of peroral endoscopic myotomy (POEM) in the treatment of achalasia: a systematic review and meta-analysis. Surg Endosc. 2015;29:3030–3046. https://doi.org/10.1007/s00464-014-4040-6.

    Article  PubMed  Google Scholar 

  169. Repici A, Fuccio L, Maselli R, et al. GERD after per-oral endoscopic myotomy as compared with Heller’s myotomy with fundoplication: a systematic review with meta-analysis. Gastrointest Endosc. 2018;87:e18. https://doi.org/10.1016/j.gie.2017.10.022.

    Article  Google Scholar 

  170. Shah ED, Chang AC, Law R. Valuing innovative endoscopic techniques: per-oral endoscopic myotomy for the management of achalasia. Gastrointest Endosc. 2019;89:264–273. https://doi.org/10.1016/j.gie.2018.04.2341.

    Article  PubMed  Google Scholar 

  171. Bloomston M, Fraiji E, Boyce HW Jr, Gonzalvo A, Johnson M, Rosemurgy AS. Preoperative intervention does not affect esophageal muscle histology or patient outcomes in patients undergoing laparoscopic Heller myotomy. J Gastrointest Surg. 2003;7:181–188.

    PubMed  Google Scholar 

  172. Öter V, Bostancı EB, Karaman K, Sümer F, Özer İ. Effects of preoperative endoscopic pneumatic balloon dilatation on postoperative achalasia symptoms after Heller esophageal myotomy plus Dor fundoplication. Turk J Gastroenterol. 2018;29:543–548. https://doi.org/10.5152/tjg.2018.17822.

    Article  PubMed  PubMed Central  Google Scholar 

  173. Hulselmans M, Vanuytsel T, Degreef T, et al. Long-term outcome of pneumatic dilation in the treatment of achalasia. Clin Gastroenterol Hepatol. 2010;8:30–35. https://doi.org/10.1016/j.cgh.2009.09.020.

    Article  PubMed  Google Scholar 

  174. Costantini M, Salvador R, Capovilla G, et al. A thousand and one laparoscopic Heller myotomies for esophageal achalasia: a 25-year experience at a single tertiary center. J Gastrointest Surg. 2019;23:23–35. https://doi.org/10.1007/s11605-018-3956-x.

    Article  PubMed  Google Scholar 

  175. Petersen RP, Pellegrini CA. Revisional surgery after Heller myotomy for esophageal achalasia. Surg Laparoscopic Endosc Percutan Tech. 2010;20:321–325. https://doi.org/10.1097/SLE.0b013e3181f39fdb.

    Article  Google Scholar 

  176. Jones EL, Meara MP, Pittman MR, Hazey JW, Perry KA. Prior treatment does not influence the performance or early outcome of per-oral endoscopic myotomy for achalasia. Surg Endosc. 2016;30:1282–1286. https://doi.org/10.1007/s00464-015-4339-y.

    Article  PubMed  Google Scholar 

  177. Tyberg A, Sharaiha RZ, Familiari P, et al. Peroral endoscopic myotomy as salvation technique post-Heller: international experience. Surg Laparosc Endosc Percutan Tech. 2018;30:52–56. https://doi.org/10.1111/den.12918.

    Article  Google Scholar 

  178. Tyberg A, Seewald S, Sharaiha RZ, et al. A multicenter international registry of redo per-oral endoscopic myotomy (POEM) after failed POEM. Gastrointest Endosc. 2017;85:1208–1211. https://doi.org/10.1016/j.gie.2016.10.015.

    Article  PubMed  Google Scholar 

  179. Giulini L, Dubecz A, Stein HJ. Laparoscopic Heller myotomy after failed POEM and multiple balloon dilatations: better late than never [German]. Chirug. 2017;88:303–306. https://doi.org/10.1007/s00104-016-0332-9.

    Article  CAS  Google Scholar 

  180. Duranceau A, Liberman M, Martin J, Ferraro P. End-stage achalasia. Dis Esophagus. 2012;25:319–330. https://doi.org/10.1111/j.1442-2050.2010.01157.x.

    Article  CAS  PubMed  Google Scholar 

  181. Miller DL, Allen MS, Trastek VF, Deschamps C, Pairolero PC. Esophageal resection for recurrent achalasia. Ann Thorac Surg. 1995;60:922–925. (discussion 925–6).

    CAS  PubMed  Google Scholar 

  182. Aiolfi A, Asti E, Bonitta G, Siboni S, Bonavina L. Esophageal resection for end-stage achalasia. Am Surg. 2018;84:506–511.

    PubMed  Google Scholar 

  183. Panchanatheeswaran K, Parshad R, Rohila J, Saraya A, Makharia GK, Sharma R. Laparoscopic Heller’s cardiomyotomy: a viable treatment option for sigmoid oesophagus. Interact Cardiovasc Thorac Surg. 2013;16:49–54. https://doi.org/10.1093/icvts/ivs427.

    Article  PubMed  Google Scholar 

  184. Hu JW, Li QL, Zhou PH, et al. Peroral endoscopic myotomy for advanced achalasia with sigmoid-shaped esophagus: long-term outcomes from a prospective, single-center study. Surg Endosc. 2015;29:2841–2850. https://doi.org/10.1007/s00464-014-4013-9.

    Article  PubMed  Google Scholar 

  185. Zaninotto G, Rizzetto C, Zambon P, Guzzinati S, Finotti E, Costantini M. Long-term outcome and risk of oesophageal cancer after surgery for achalasia. Br J Surg. 2008;95:1488–1494. https://doi.org/10.1002/bjs.6413.

    Article  CAS  PubMed  Google Scholar 

  186. Leeuwenburgh I, Scholten P, Alderliesten J, et al. Long-term esophageal cancer risk in patients with primary achalasia: a prospective study. Am J Gastroenterol. 2010;105:2144–2149. https://doi.org/10.1038/ajg.2010.263.

    Article  CAS  PubMed  Google Scholar 

  187. Tustumi F, Bernardo WM, da Rocha JRM, et al. Esophageal achalasia: a risk factor for carcinom. A systematic review and meta-analysis. Dis Esophagus. 2017;30:1–8. https://doi.org/10.1093/dote/dox072.

    CAS  PubMed  Google Scholar 

  188. Eckardt AJ, Eckardt VF. Editorial: cancer surveillance in achalasia: better late than never? Am J Gastroenterol. 2010;105:2150–2152. https://doi.org/10.1038/ajg.2010.257.

    Article  PubMed  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, MOB #602, William Beaumont Hospital, 3535 W. Thirteen Mile Rd, Royal Oak, MI, 48073, USA

    Mitchell S. Cappell

  2. Oakland University William Beaumont School of Medicine, MOB #602, William Beaumont Hospital, 3535 W. Thirteen Mile Rd, Royal Oak, MI, 48073, USA

    Mitchell S. Cappell

  3. Division of Gastroenterology, New York University Winthrop Medical Center, Mineola, NY, 11501, USA

    Stavros Nicholas Stavropoulos & David Friedel

Authors
  1. Mitchell S. Cappell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stavros Nicholas Stavropoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Friedel
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Dr. Cappell initiated this comprehensive review and wrote most of the manuscript with Dr. Friedel. Dr. Stavropoulos provided critical contributions to the section on therapies for achalasia, especially POEM.

Corresponding author

Correspondence to Mitchell S. Cappell.

Ethics declarations

Conflicts of interest

Dr. Cappell, Dr. Stavropoulos, and Dr. Friedel declare that they have no conflict of interest. In particular, Dr. Cappell, as a consultant of the United States Food and Drug Administration (FDA) Advisory Committee for Gastroenterology Drugs, affirms that this paper does not discuss any proprietary confidential pharmaceutical data submitted to the FDA and reviewed by Dr. Cappell. Dr. Cappell was until 1 year ago a member of the speaker’s bureau for AstraZeneca and Daiichi Sankyo, co-marketers of Movantik. Dr. Cappell has had one-time consultancies for Mallinckrodt and Shire. This work does not discuss any drug manufactured or marketed by AstraZeneca, Daiichi Sankyo, Shire, or Mallinckrodt.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cappell, M.S., Stavropoulos, S.N. & Friedel, D. Updated Systematic Review of Achalasia, with a Focus on POEM Therapy. Dig Dis Sci 65, 38–65 (2020). https://doi.org/10.1007/s10620-019-05784-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-019-05784-3

Keywords

Search

Navigation