Advertisement

Achalasia

  • Rishi D. NaikEmail author
  • Dhyanesh A. Patel
Chapter

Abstract

Achalasia is a primary disorder of esophageal motility and is the most common motor neuron disorder of the esophagus. Classic presentation involves dysphagia to solids and liquids with regurgitation and chest pain. The gold standard test is using high-resolution manometry to evaluate the motility of the esophagus when an endoscopy has ruled out causes of pseudo-achalasia, such as a cancer at the gastroesophageal junction. Endoscopic appearance of the esophagus at the lower esophageal sphincter often shows a “puckered appearance” with retained food or saliva proximal to this narrowing. Barium esophagram may reveal distal tapering of the lower esophageal sphincter giving the classic “bird beak’s appearance.” Several therapeutic options for achalasia are available including both endoscopic and surgical options for those able to tolerate the risks of these procedures. Increased attention has been placed on management based on subtype of achalasia to direct a personalized approach. Limitations of the current state of achalasia include the lack of etiological risk factor and lack of curative approaches. The goals of therapy are to improve symptoms and prevent esophageal stasis. Future work guided at understanding fundamental causal factors of achalasia, which may provide insight to more durable therapies is needed.

Keywords

Esophageal peristalsis EPT EGJOO Esophagogastroduodenoscopy Functional lumen imaging probe Botulinum toxin injection Pneumatic dilation POEM Laparoscopic Heller myotomy 

References

  1. 1.
    Goldblum JR, Rice TW, Richter JE. Histopathologic features in esophagomyotomy specimens from patients with achalasia. Gastroenterology. 1996;111:648–54.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Frieling T, et al. Family occurrence of achalasia and diffuse spasm of the oesophagus. Gut. 1988;29:1595–602.  https://doi.org/10.1136/gut.29.11.1595.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Farrukh A, DeCaestecker J, Mayberry JF. An epidemiological study of achalasia among the South Asian population of Leicester, 1986–2005. Dysphagia. 2008;23:161–4.  https://doi.org/10.1007/s00455-007-9116-1.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Birgisson S, Richter JE. Achalasia in Iceland, 1952–2002: an epidemiologic study. Dig Dis Sci. 2007;52:1855–60.  https://doi.org/10.1007/s10620-006-9286-y.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Sadowski DC, Ackah F, Jiang B, Svenson LW. Achalasia: incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil. 2010;22:e256–61.  https://doi.org/10.1111/j.1365-2982.2010.01511.x.CrossRefGoogle Scholar
  6. 6.
    Enestvedt BK, Williams JL, Sonnenberg A. Epidemiology and practice patterns of achalasia in a large multi-centre database. Aliment Pharmacol Ther. 2011;33:1209–14.  https://doi.org/10.1111/j.1365-2036.2011.04655.x.CrossRefGoogle Scholar
  7. 7.
    Nenshi R, et al. The cost of achalasia: quantifying the effect of symptomatic disease on patient cost burden, treatment time, and work productivity. Surg Innov. 2010;17:291–4.  https://doi.org/10.1177/1553350610376392.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Sonnenberg A. Hospitalization for achalasia in the United States 1997–2006. Dig Dis Sci. 2009;54:1680–5.  https://doi.org/10.1007/s10620-009-0863-8.CrossRefGoogle Scholar
  9. 9.
    Sonnenberg A, Massey BT, McCarty DJ, Jacobsen SJ. Epidemiology of hospitalization for achalasia in the United States. Dig Dis Sci. 1993;38:233–44.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Vaezi MF, Richter JE. Diagnosis and management of achalasia. American College of Gastroenterology Practice Parameter Committee. Am J Gastroenterol. 1999;94:3406–12.  https://doi.org/10.1111/j.1572-0241.1999.01639.x.CrossRefPubMedGoogle Scholar
  11. 11.
    Francis DL, Katzka DA. Achalasia: update on the disease and its treatment. Gastroenterology. 2010;139:369–74.  https://doi.org/10.1053/j.gastro.2010.06.024.CrossRefPubMedGoogle Scholar
  12. 12.
    Johnston BT, et al. Repetitive proximal esophageal contractions: a new manometric finding and a possible further link between Parkinson’s disease and achalasia. Dysphagia. 2001;16:186–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Viegelmann G, Low Y, Sriram B, Chu HP. Achalasia and Down syndrome: a unique association not to be missed. Singapore Med J. 2014;55:e107–8.  https://doi.org/10.11622/smedj.2013260.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Jung KW, et al. Genetic evaluation of ALADIN gene in early-onset achalasia and alacrima patients. J Neurogastroenterol Motil. 2011;17:169–73.  https://doi.org/10.5056/jnm.2011.17.2.169.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Stuckey BG, Mastaglia FL, Reed WD, Pullan PT. Glucocorticoid insufficiency, achalasia, alacrima with autonomic motor neuropathy. Ann Intern Med. 1987;106:61–3.PubMedCrossRefGoogle Scholar
  16. 16.
    Sarathi V, Shah NS. Triple-A syndrome. Adv Exp Med Biol. 2010;685:1–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Gordillo-Gonzalez G, et al. Achalasia familiar: report of a family with an autosomal dominant pattern of inherence. Dis Esophagus. 2011;24:E1–4.  https://doi.org/10.1111/j.1442-2050.2010.01124.x.CrossRefPubMedGoogle Scholar
  18. 18.
    Vigo AG, Martinez A, de la Concha EG, Urcelay E, Ruiz de Leon A. Suggested association of NOS2A polymorphism in idiopathic achalasia: no evidence in a large case-control study. Am J Gastroenterol. 2009;104:1326–7.  https://doi.org/10.1038/ajg.2009.72.CrossRefPubMedGoogle Scholar
  19. 19.
    de Leon AR, et al. Association between idiopathic achalasia and IL23R gene. Neurogastroenterol Motil. 2010;22:734–738, e218.  https://doi.org/10.1111/j.1365-2982.2010.01497.x.CrossRefPubMedGoogle Scholar
  20. 20.
    Nunez C, et al. Association of IL10 promoter polymorphisms with idiopathic achalasia. Hum Immunol. 2011;72:749–52.  https://doi.org/10.1016/j.humimm.2011.05.017.CrossRefPubMedGoogle Scholar
  21. 21.
    Wong RK, Maydonovitch CL, Metz SJ, Baker JR Jr. Significant DQw1 association in achalasia. Dig Dis Sci. 1989;34:349–52.PubMedCrossRefGoogle Scholar
  22. 22.
    De la Concha EG, et al. Contribution of HLA class II genes to susceptibility in achalasia. Tissue Antigens. 1998;52:381–4.PubMedCrossRefGoogle Scholar
  23. 23.
    Verne GN, et al. Association of HLA-DR and -DQ alleles with idiopathic achalasia. Gastroenterology. 1999;117:26–31.PubMedCrossRefGoogle Scholar
  24. 24.
    Gockel I, et al. Common variants in the HLA-DQ region confer susceptibility to idiopathic achalasia. Nat Genet. 2014;46:901–4.  https://doi.org/10.1038/ng.3029.CrossRefPubMedGoogle Scholar
  25. 25.
    Furuzawa-Carballeda J, et al. Achalasia--an autoimmune inflammatory disease: a cross-sectional study. J Immunol Res. 2015;2015:729217.  https://doi.org/10.1155/2015/729217.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Furuzawa-Carballeda J, et al. New insights into the pathophysiology of achalasia and implications for future treatment. World J Gastroenterol: WJG. 2016;22:7892–907.  https://doi.org/10.3748/wjg.v22.i35.7892.CrossRefPubMedGoogle Scholar
  27. 27.
    Booy JD, Takata J, Tomlinson G, Urbach DR. The prevalence of autoimmune disease in patients with esophageal achalasia. Dis Esophagus. 2012;25:209–13.  https://doi.org/10.1111/j.1442-2050.2011.01249.x.CrossRefPubMedGoogle Scholar
  28. 28.
    Patel DA, Lappas BM, Vaezi MF. An overview of achalasia and its subtypes. Gastroenterol Hepatol (NY). 2017;13:411–21.Google Scholar
  29. 29.
    Park W, Vaezi MF. Etiology and pathogenesis of achalasia: the current understanding. Am J Gastroenterol. 2005;100:1404–14.  https://doi.org/10.1111/j.1572-0241.2005.41775.x.CrossRefPubMedGoogle Scholar
  30. 30.
    Kuramoto H, Kadowaki M, Yoshida N. Morphological demonstration of a vagal inhibitory pathway to the lower esophageal sphincter via nitrergic neurons in the rat esophagus. Neurogastroenterol Motil. 2013;25:e485–94.  https://doi.org/10.1111/nmo.12146.CrossRefPubMedGoogle Scholar
  31. 31.
    Murray J, Du C, Ledlow A, Bates JN, Conklin JL. Nitric oxide: mediator of nonadrenergic noncholinergic responses of opossum esophageal muscle. Am J Physiol. 1991;261:G401–6.PubMedGoogle Scholar
  32. 32.
    Guelrud M, et al. The effect of vasoactive intestinal polypeptide on the lower esophageal sphincter in achalasia. Gastroenterology. 1992;103:377–82.PubMedCrossRefGoogle Scholar
  33. 33.
    Boeckxstaens GE. Achalasia: virus-induced euthanasia of neurons? Am J Gastroenterol. 2008;103:1610–2.  https://doi.org/10.1111/j.1572-0241.2008.01967.x.CrossRefGoogle Scholar
  34. 34.
    Kraichely RE, Farrugia G, Pittock SJ, Castell DO, Lennon VA. Neural autoantibody profile of primary achalasia. Dig Dis Sci. 2010;55:307–11.  https://doi.org/10.1007/s10620-009-0838-9.CrossRefGoogle Scholar
  35. 35.
    de Oliveira RB, Rezende Filho J, Dantas RO, Iazigi N. The spectrum of esophageal motor disorders in Chagas’ disease. Am J Gastroenterol. 1995;90:1119–24.PubMedGoogle Scholar
  36. 36.
    Mearin F, et al. Patients with achalasia lack nitric oxide synthase in the gastro-oesophageal junction. Eur J Clin Invest. 1993;23:724–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Kahrilas PJ, Boeckxstaens G. The spectrum of achalasia: lessons from studies of pathophysiology and high-resolution manometry. Gastroenterology. 2013;145:954–65.  https://doi.org/10.1053/j.gastro.2013.08.038.CrossRefPubMedGoogle Scholar
  38. 38.
    Ates F, Vaezi MF. The pathogenesis and management of achalasia: current status and future directions. Gut Liver. 2015;9:449–63.  https://doi.org/10.5009/gnl14446.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Dowlatshahi K, Evander A, Walther B, Skinner DB. Influence of morphine on the distal oesophagus and the lower oesophageal sphincter--a manometric study. Gut. 1985;26:802–6.  https://doi.org/10.1136/gut.26.8.802.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Penagini R, Bianchi PA. Effect of morphine on gastroesophageal reflux and transient lower esophageal sphincter relaxation. Gastroenterology. 1997;113:409–14.PubMedCrossRefGoogle Scholar
  41. 41.
    Penagini R, Picone A, Bianchi PA. Effect of morphine and naloxone on motor response of the human esophagus to swallowing and distension. Am J Physiol. 1996;271:G675–80.  https://doi.org/10.1152/ajpgi.1996.271.4.G675.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Kraichely RE, Arora AS, Murray JA. Opiate-induced oesophageal dysmotility. Aliment Pharmacol Ther. 2010;31:601–6.  https://doi.org/10.1111/j.1365-2036.2009.04212.x.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Gonzalez ES, Bellver VO, Jaime FC, Cortes JA, Gil VG. Opioid-induced lower esophageal sphincter dysfunction. J Neurogastroenterol Motil. 2015;21:618–20.  https://doi.org/10.5056/jnm15108.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Babaei A, Szabo A, Shad S, Massey BT. Chronic daily opioid exposure is associated with dysphagia, esophageal outflow obstruction, and disordered peristalsis. Neurogastroenterol Motil. 2019;31:e13601.  https://doi.org/10.1111/nmo.13601.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Ratuapli SK, et al. Opioid-induced esophageal dysfunction (OIED) in patients on chronic opioids. Am J Gastroenterol. 2015;110:979–84.  https://doi.org/10.1038/ajg.2015.154.CrossRefGoogle Scholar
  46. 46.
    Ortiz V, Garcia-Campos M, Saez-Gonzalez E, del Pozo P, Garrigues V. A concise review of opioid-induced esophageal dysfunction: is this a new clinical entity? Dis Esophagus. 2018;31:doy003.  https://doi.org/10.1093/dote/doy003.CrossRefGoogle Scholar
  47. 47.
    Kahrilas PJ, Bredenoord AJ, Carlson DA, Pandolfino JE. Advances in management of esophageal motility disorders. Clin Gastroenterol Hepatol. 2018;16:1692–700.  https://doi.org/10.1016/j.cgh.2018.04.026.CrossRefPubMedGoogle Scholar
  48. 48.
    Schechter RB, Lemme EM, Novais P, Biccas B. Achalasia in the elderly patient: a comparative study. Arq Gastroenterol. 2011;48:19–23.PubMedCrossRefGoogle Scholar
  49. 49.
    Rakita SS, Villadolid D, Kalipersad C, Thometz D, Rosemurgy A. BMI affects presenting symptoms of achalasia and outcome after Heller myotomy. Surg Endosc. 2007;21:258–64.  https://doi.org/10.1007/s00464-006-0113-5.CrossRefPubMedGoogle Scholar
  50. 50.
    Patel DA, et al. Weight loss in achalasia is determined by its phenotype. Dis Esophagus. 2018;31:doy046.  https://doi.org/10.1093/dote/doy046.CrossRefGoogle Scholar
  51. 51.
    Khandelwal S, et al. Improvement of respiratory symptoms following Heller myotomy for achalasia. J Gastrointest Surg. 2011;15:235–9.  https://doi.org/10.1007/s11605-010-1397-2.CrossRefPubMedGoogle Scholar
  52. 52.
    Sinan H, et al. Prevalence of respiratory symptoms in patients with achalasia. Dis Esophagus. 2011;24:224–8.  https://doi.org/10.1111/j.1442-2050.2010.01126.x.CrossRefPubMedGoogle Scholar
  53. 53.
    Gupta M, et al. Respiratory dysfunction is common in patients with achalasia and improves after pneumatic dilation. Dig Dis Sci. 2014;59:744–52.  https://doi.org/10.1007/s10620-013-2971-8.CrossRefGoogle Scholar
  54. 54.
    Clouse RE, Staiano A. Topography of the esophageal peristaltic pressure wave. Am J Physiol. 1991;261:G677–84.PubMedGoogle Scholar
  55. 55.
    Kahrilas PJ, et al. The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27:160–74.  https://doi.org/10.1111/nmo.12477.CrossRefGoogle Scholar
  56. 56.
    Pandolfino JE, et al. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology. 2008;135:1526–33.  https://doi.org/10.1053/j.gastro.2008.07.022.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Rohof WO, et al. Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterology. 2013;144:718–25; quiz e713–714.  https://doi.org/10.1053/j.gastro.2012.12.027.CrossRefGoogle Scholar
  58. 58.
    Sodikoff JB, et al. Histopathologic patterns among achalasia subtypes. Neurogastroenterol Motil. 2016;28:139–45.  https://doi.org/10.1111/nmo.12711.CrossRefPubMedGoogle Scholar
  59. 59.
    Scherer JR, Kwiatek MA, Soper NJ, Pandolfino JE, Kahrilas PJ. Functional esophagogastric junction obstruction with intact peristalsis: a heterogeneous syndrome sometimes akin to achalasia. J Gastrointest Surg. 2009;13:2219–25.  https://doi.org/10.1007/s11605-009-0975-7.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    van Hoeij FB, Smout AJ, Bredenoord AJ. Characterization of idiopathic esophagogastric junction outflow obstruction. Neurogastroenterol Motil. 2015;27:1310–6.  https://doi.org/10.1111/nmo.12625.CrossRefPubMedGoogle Scholar
  61. 61.
    Perez-Fernandez MT, Santander C, Marinero A, Burgos-Santamaria D, Chavarria-Herbozo C. Characterization and follow-up of esophagogastric junction outflow obstruction detected by high resolution manometry. Neurogastroenterol Motil. 2016;28:116–26.  https://doi.org/10.1111/nmo.12708.CrossRefPubMedGoogle Scholar
  62. 62.
    Sweis R, Anggiansah A, Wong T, Brady G, Fox M. Assessment of esophageal dysfunction and symptoms during and after a standardized test meal: development and clinical validation of a new methodology utilizing high-resolution manometry. Neurogastroenterol Motil. 2014;26:215–28.  https://doi.org/10.1111/nmo.12252.CrossRefPubMedGoogle Scholar
  63. 63.
    Ang D, et al. Rapid Drink Challenge in high-resolution manometry: an adjunctive test for detection of esophageal motility disorders. Neurogastroenterol Motil. 2017;29:e12902.  https://doi.org/10.1111/nmo.12902.CrossRefGoogle Scholar
  64. 64.
    Bogte A, Bredenoord AJ, Oors J, Siersema PD, Smout AJ. Reproducibility of esophageal high-resolution manometry. Neurogastroenterol Motil. 2011;23:e271–6.  https://doi.org/10.1111/j.1365-2982.2011.01713.x.CrossRefPubMedGoogle Scholar
  65. 65.
    Fox M, et al. High-resolution manometry predicts the success of oesophageal bolus transport and identifies clinically important abnormalities not detected by conventional manometry. Neurogastroenterol Motil. 2004;16:533–42.  https://doi.org/10.1111/j.1365-2982.2004.00539.x.CrossRefPubMedGoogle Scholar
  66. 66.
    Lin Z, et al. Refining the criterion for an abnormal Integrated Relaxation Pressure in esophageal pressure topography based on the pattern of esophageal contractility using a classification and regression tree model. Neurogastroenterol Motil. 2012;24:e356–63.  https://doi.org/10.1111/j.1365-2982.2012.01952.x.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Ponds FA, Bredenoord AJ, Kessing BF, Smout AJ. Esophagogastric junction distensibility identifies achalasia subgroup with manometrically normal esophagogastric junction relaxation. Neurogastroenterol Motil. 2017;29:e12908.  https://doi.org/10.1111/nmo.12908.CrossRefGoogle Scholar
  68. 68.
    Pandolfino JE, et al. Distensibility of the esophagogastric junction assessed with the functional lumen imaging probe (FLIP) in achalasia patients. Neurogastroenterol Motil. 2013;25:496–501.  https://doi.org/10.1111/nmo.12097.CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Lin Z, et al. Flow time through esophagogastric junction derived during high-resolution impedance-manometry studies: a novel parameter for assessing esophageal bolus transit. Am J Physiol Gastrointest Liver Physiol. 2014;307:G158–63.  https://doi.org/10.1152/ajpgi.00119.2014.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Lin Z, et al. High-resolution impedance manometry measurement of bolus flow time in achalasia and its correlation with dysphagia. Neurogastroenterol Motil. 2015;27:1232–8.  https://doi.org/10.1111/nmo.12613.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Fornari F, Bravi I, Penagini R, Tack J, Sifrim D. Multiple rapid swallowing: a complementary test during standard oesophageal manometry. Neurogastroenterol Motil. 2009;21:718–e741.  https://doi.org/10.1111/j.1365-2982.2009.01273.x.CrossRefPubMedGoogle Scholar
  72. 72.
    Teitelbaum EN, et al. An extended proximal esophageal myotomy is necessary to normalize EGJ distensibility during Heller myotomy for achalasia, but not POEM. Surg Endosc. 2014;28:2840–7.  https://doi.org/10.1007/s00464-014-3563-1.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Teitelbaum EN, et al. Esophagogastric junction distensibility measurements during Heller myotomy and POEM for achalasia predict postoperative symptomatic outcomes. Surg Endosc. 2015;29:522–8.  https://doi.org/10.1007/s00464-014-3733-1.CrossRefPubMedGoogle Scholar
  74. 74.
    Ngamruengphong S, 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;30:2886–94.  https://doi.org/10.1007/s00464-015-4574-2.CrossRefGoogle Scholar
  75. 75.
    Vaezi MF, Richter JE. Current therapies for achalasia: comparison and efficacy. J Clin Gastroenterol. 1998;27:21–35.PubMedCrossRefGoogle Scholar
  76. 76.
    Gelfond M, Rozen P, Gilat T. Isosorbide dinitrate and nifedipine treatment of achalasia: a clinical, manometric and radionuclide evaluation. Gastroenterology. 1982;83:963–9.Google Scholar
  77. 77.
    Rozen P, Gelfond M, Salzman S, Baron J, Gilat T. Radionuclide confirmation of the therapeutic value of isosorbide dinitrate in relieving the dysphagia in achalasia. J Clin Gastroenterol. 1982;4:17–22.PubMedCrossRefGoogle Scholar
  78. 78.
    Gelfond M, Rozen P, Keren S, Gilat T. Effect of nitrates on LOS pressure in achalasia: a potential therapeutic aid. Gut. 1981;22:312–8.  https://doi.org/10.1136/gut.22.4.312.CrossRefPubMedPubMedCentralGoogle Scholar
  79. 79.
    Traube M, Dubovik S, Lange RC, McCallum RW. The role of nifedipine therapy in achalasia: results of a randomized, double-blind, placebo-controlled study. Am J Gastroenterol. 1989;84:1259–62.PubMedGoogle Scholar
  80. 80.
    Bortolotti M, Labo G. Clinical and manometric effects of nifedipine in patients with esophageal achalasia. Gastroenterology. 1981;80:39–44.PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    Coccia G, Bortolotti M, Michetti P, Dodero M. Prospective clinical and manometric study comparing pneumatic dilatation and sublingual nifedipine in the treatment of oesophageal achalasia. Gut. 1991;32:604–6.  https://doi.org/10.1136/gut.32.6.604.CrossRefPubMedPubMedCentralGoogle Scholar
  82. 82.
    Eherer AJ, et al. Effect of sildenafil on oesophageal motor function in healthy subjects and patients with oesophageal motor disorders. Gut. 2002;50:758–64.  https://doi.org/10.1136/gut.50.6.758.CrossRefPubMedPubMedCentralGoogle Scholar
  83. 83.
    Vaezi MF, et al. Botulinum toxin versus pneumatic dilatation in the treatment of achalasia: a randomised trial. Gut. 1999;44:231–9.  https://doi.org/10.1136/gut.44.2.231.CrossRefPubMedPubMedCentralGoogle Scholar
  84. 84.
    Pasricha PJ, Rai R, Ravich WJ, Hendrix TR, Kalloo AN. Botulinum toxin for achalasia: long-term outcome and predictors of response. Gastroenterology. 1996;110:1410–5.CrossRefGoogle Scholar
  85. 85.
    Pasricha PJ, et al. Intrasphincteric botulinum toxin for the treatment of achalasia. N Engl J Med. 1995;332:774–8.  https://doi.org/10.1056/NEJM199503233321203.CrossRefPubMedPubMedCentralGoogle Scholar
  86. 86.
    Pasricha PJ, Ravich WJ, Kalloo AN. Botulinum toxin for achalasia. Lancet. 1993;341:244–5.PubMedCrossRefPubMedCentralGoogle Scholar
  87. 87.
    Annese V, et al. A multicentre randomised study of intrasphincteric botulinum toxin in patients with oesophageal achalasia. GISMAD Achalasia Study Group. Gut. 2000;46:597–600.  https://doi.org/10.1136/gut.46.5.597.CrossRefPubMedPubMedCentralGoogle Scholar
  88. 88.
    Cuilliere C, et al. Achalasia: outcome of patients treated with intrasphincteric injection of botulinum toxin. Gut. 1997;41:87–92.  https://doi.org/10.1136/gut.41.1.87.CrossRefPubMedPubMedCentralGoogle Scholar
  89. 89.
    Rollan A, Gonzalez R, Carvajal S, Chianale J. Endoscopic intrasphincteric injection of botulinum toxin for the treatment of achalasia. J Clin Gastroenterol. 1995;20:189–91.PubMedCrossRefPubMedCentralGoogle Scholar
  90. 90.
    Fishman VM, et al. Symptomatic improvement in achalasia after botulinum toxin injection of the lower esophageal sphincter. Am J Gastroenterol. 1996;91:1724–30.PubMedPubMedCentralGoogle Scholar
  91. 91.
    Annese V, et al. Controlled trial of botulinum toxin injection versus placebo and pneumatic dilation in achalasia. Gastroenterology. 1996;111:1418–24.PubMedCrossRefPubMedCentralGoogle Scholar
  92. 92.
    Gordon JM, Eaker EY. Prospective study of esophageal botulinum toxin injection in high-risk achalasia patients. Am J Gastroenterol. 1997;92:1812–7.PubMedPubMedCentralGoogle Scholar
  93. 93.
    Muehldorfer SM, et al. Esophageal achalasia: intrasphincteric injection of botulinum toxin A versus balloon dilation. Endoscopy. 1999;31:517–21.  https://doi.org/10.1055/s-1999-56.CrossRefPubMedPubMedCentralGoogle Scholar
  94. 94.
    Kolbasnik J, Waterfall WE, Fachnie B, Chen Y, Tougas G. Long-term efficacy of Botulinum toxin in classical achalasia: a prospective study. Am J Gastroenterol. 1999;94:3434–9.  https://doi.org/10.1111/j.1572-0241.1999.01605.x.CrossRefPubMedPubMedCentralGoogle Scholar
  95. 95.
    Mikaeli J, Fazel A, Montazeri G, Yaghoobi M, Malekzadeh R. Randomized controlled trial comparing botulinum toxin injection to pneumatic dilatation for the treatment of achalasia. Aliment Pharmacol Ther. 2001;15:1389–96.PubMedCrossRefPubMedCentralGoogle Scholar
  96. 96.
    Allescher HD, et al. Treatment of achalasia: botulinum toxin injection vs. pneumatic balloon dilation. A prospective study with long-term follow-up. Endoscopy. 2001;33:1007–17.  https://doi.org/10.1055/s-2001-18935.CrossRefPubMedPubMedCentralGoogle Scholar
  97. 97.
    Neubrand M, Scheurlen C, Schepke M, Sauerbruch T. Long-term results and prognostic factors in the treatment of achalasia with botulinum toxin. Endoscopy. 2002;34:519–23.  https://doi.org/10.1055/s-2002-33225.CrossRefPubMedPubMedCentralGoogle Scholar
  98. 98.
    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;243:579–84; discussion 584–576.  https://doi.org/10.1097/01.sla.0000217524.75529.2d.CrossRefPubMedPubMedCentralGoogle Scholar
  99. 99.
    Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol. 2013;108:1238–49; quiz 1250.  https://doi.org/10.1038/ajg.2013.196.CrossRefPubMedPubMedCentralGoogle Scholar
  100. 100.
    Lambroza A, Schuman RW. Pneumatic dilation for achalasia without fluoroscopic guidance: safety and efficacy. Am J Gastroenterol. 1995;90:1226–9.PubMedGoogle Scholar
  101. 101.
    Thomas V, Harish K, Sunilkumar K. Pneumatic dilation of achalasia cardia under direct endoscopy: the debate continues. Gastrointest Endosc. 2006;63:734.  https://doi.org/10.1016/j.gie.2005.11.023.CrossRefPubMedGoogle Scholar
  102. 102.
    Vela MF, et al. The long-term efficacy of pneumatic dilatation and Heller myotomy for the treatment of achalasia. Clin Gastroenterol Hepatol. 2006;4:580–7.CrossRefGoogle Scholar
  103. 103.
    Campos GM, 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.CrossRefGoogle Scholar
  104. 104.
    Cox J, Buckton GK, Bennett JR. Balloon dilatation in achalasia: a new dilator. Gut. 1986;27:986–9.  https://doi.org/10.1136/gut.27.8.986.CrossRefPubMedPubMedCentralGoogle Scholar
  105. 105.
    Gelfand MD, Kozarek RA. An experience with polyethylene balloons for pneumatic dilation in achalasia. Am J Gastroenterol. 1989;84:924–7.PubMedGoogle Scholar
  106. 106.
    Barkin JS, Guelrud M, Reiner DK, Goldberg RI, Phillips RS. Forceful balloon dilation: an outpatient procedure for achalasia. Gastrointest Endosc. 1990;36:123–6.PubMedCrossRefGoogle Scholar
  107. 107.
    Stark GA, Castell DO, Richter JE, Wu WC. Prospective randomized comparison of Brown-McHardy and microvasive balloon dilators in treatment of achalasia. Am J Gastroenterol. 1990;85:1322–6.PubMedGoogle Scholar
  108. 108.
    Makela J, Kiviniemi H, Laitinen S. Heller’s cardiomyotomy compared with pneumatic dilatation for treatment of oesophageal achalasia. Eur J Surg. 1991;157:411–4.PubMedGoogle Scholar
  109. 109.
    Levine ML, Moskowitz GW, Dorf BS, Bank S. Pneumatic dilation in patients with achalasia with a modified Gruntzig dilator (Levine) under direct endoscopic control: results after 5 years. Am J Gastroenterol. 1991;86:1581–4.PubMedGoogle Scholar
  110. 110.
    Kim CH, et al. Achalasia: prospective evaluation of relationship between lower esophageal sphincter pressure, esophageal transit, and esophageal diameter and symptoms in response to pneumatic dilation. Mayo Clin Proc. 1993;68:1067–73.  https://doi.org/10.1016/s0025-6196(12)60900-8.CrossRefPubMedGoogle Scholar
  111. 111.
    Lee JD, Cecil BD, Brown PE, Wright RA. The Cohen test does not predict outcome in achalasia after pneumatic dilation. Gastrointest Endosc. 1993;39:157–60.PubMedCrossRefGoogle Scholar
  112. 112.
    Abid S, et al. Treatment of achalasia: the best of both worlds. Am J Gastroenterol. 1994;89:979–85.Google Scholar
  113. 113.
    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;42:31–6.CrossRefGoogle Scholar
  114. 114.
    Muehldorfer SM, Hahn EG, Ell C. High- and low-compliance balloon dilators in patients with achalasia: a randomized prospective comparative trial. Gastrointest Endosc. 1996;44:398–403.PubMedCrossRefGoogle Scholar
  115. 115.
    Bhatnagar MS, Nanivadekar SA, Sawant P, Rathi PM. Achalasia cardia dilatation using polyethylene balloon (Rigiflex) dilators. Indian J Gastroenterol. 1996;15:49–51.PubMedGoogle Scholar
  116. 116.
    Gideon RM, Castell DO, Yarze J. Prospective randomized comparison of pneumatic dilatation technique in patients with idiopathic achalasia. Dig Dis Sci. 1999;44:1853–7.PubMedCrossRefGoogle Scholar
  117. 117.
    Khan AA, et al. Massively dilated esophagus in achalasia: response to pneumatic balloon dilation. Am J Gastroenterol. 1999;94:2363–6.  https://doi.org/10.1111/j.1572-0241.1999.01358.x.CrossRefPubMedGoogle Scholar
  118. 118.
    Kadakia SC, Wong RK. Graded pneumatic dilation using Rigiflex achalasia dilators in patients with primary esophageal achalasia. Am J Gastroenterol. 1993;88:34–8.PubMedGoogle Scholar
  119. 119.
    Chan KC, et al. Short-term and long-term results of endoscopic balloon dilation for achalasia: 12 years’ experience. Endoscopy. 2004;36:690–4.  https://doi.org/10.1055/s-2004-825659.CrossRefGoogle Scholar
  120. 120.
    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;10:3322–7.  https://doi.org/10.3748/wjg.v10.i22.3322.CrossRefPubMedPubMedCentralGoogle Scholar
  121. 121.
    Kostic S, 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;31:470–8.  https://doi.org/10.1007/s00268-006-0600-9.CrossRefGoogle Scholar
  122. 122.
    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;20:431–6.  https://doi.org/10.1111/j.1365-2036.2004.02080.x.CrossRefGoogle Scholar
  123. 123.
    Ghoshal UC, et al. Long-term follow-up after pneumatic dilation for achalasia cardia: factors associated with treatment failure and recurrence. Am J Gastroenterol. 2004;99:2304–10.  https://doi.org/10.1111/j.1572-0241.2004.40099.x.CrossRefPubMedGoogle Scholar
  124. 124.
    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;38:855–60.CrossRefGoogle Scholar
  125. 125.
    Boztas G, et al. Pneumatic balloon dilatation in primary achalasia: the long-term follow-up results. Hepatogastroenterology. 2005;52:475–80.PubMedGoogle Scholar
  126. 126.
    Karamanolis G, et al. Long-term outcome of pneumatic dilation in the treatment of achalasia. Am J Gastroenterol. 2005;100:270–4.  https://doi.org/10.1111/j.1572-0241.2005.40093.x.CrossRefPubMedGoogle Scholar
  127. 127.
    Katsinelos P, et al. Long-term results of pneumatic dilation for achalasia: a 15 years’ experience. World J Gastroenterol. 2005;11:5701–5.  https://doi.org/10.3748/wjg.v11.i36.5701.CrossRefPubMedPubMedCentralGoogle Scholar
  128. 128.
    Tuset JA, Lujan M, Huguet JM, Canelles P, Medina E. Endoscopic pneumatic balloon dilation in primary achalasia: predictive factors, complications, and long-term follow-up. Dis Esophagus. 2009;22:74–9.  https://doi.org/10.1111/j.1442-2050.2008.00874.x.CrossRefPubMedGoogle Scholar
  129. 129.
    Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology. 1992;103:1732–8.PubMedCrossRefGoogle Scholar
  130. 130.
    Gockel I, Junginger T, Bernhard G, Eckardt VF. Heller myotomy for failed pneumatic dilation in achalasia: how effective is it? Ann Surg. 2004;239:371–7.  https://doi.org/10.1097/01.sla.0000114228.34809.01.CrossRefPubMedPubMedCentralGoogle Scholar
  131. 131.
    Farhoomand K, Connor JT, Richter JE, Achkar E, Vaezi MF. Predictors of outcome of pneumatic dilation in achalasia. Clin Gastroenterol Hepatol. 2004;2:389–94.CrossRefGoogle Scholar
  132. 132.
    Salvador R, et al. The preoperative manometric pattern predicts the outcome of surgical treatment for esophageal achalasia. J Gastrointest Surg. 2010;14:1635–45.  https://doi.org/10.1007/s11605-010-1318-4.CrossRefPubMedGoogle Scholar
  133. 133.
    Eckardt VF, Kanzler G, Westermeier T. Complications and their impact after pneumatic dilation for achalasia: prospective long-term follow-up study. Gastrointest Endosc. 1997;45:349–53.PubMedCrossRefGoogle Scholar
  134. 134.
    Vanuytsel T, et al. Conservative management of esophageal perforations during pneumatic dilation for idiopathic esophageal achalasia. Clin Gastroenterol Hepatol. 2012;10:142–9.  https://doi.org/10.1016/j.cgh.2011.10.032.CrossRefPubMedGoogle Scholar
  135. 135.
    Inoue H, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42:265–71.  https://doi.org/10.1055/s-0029-1244080.CrossRefGoogle Scholar
  136. 136.
    Bhayani NH, et al. A comparative study on comprehensive, objective outcomes of laparoscopic Heller myotomy with per-oral endoscopic myotomy (POEM) for achalasia. Ann Surg. 2014;259:1098–103.  https://doi.org/10.1097/SLA.0000000000000268.CrossRefGoogle Scholar
  137. 137.
    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;27:3322–38.  https://doi.org/10.1007/s00464-013-2913-8.CrossRefGoogle Scholar
  138. 138.
    Lujan-Sanchis M, et al. Management of primary achalasia: the role of endoscopy. World J Gastrointest Endosc. 2015;7:593–605.  https://doi.org/10.4253/wjge.v7.i6.593.CrossRefPubMedPubMedCentralGoogle Scholar
  139. 139.
    Bechara R, Ikeda H, Inoue H. Peroral endoscopic myotomy: an evolving treatment for achalasia. Nat Rev Gastroenterol Hepatol. 2015;12:410–26.  https://doi.org/10.1038/nrgastro.2015.87.CrossRefGoogle Scholar
  140. 140.
    Tan Y, 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.CrossRefGoogle Scholar
  141. 141.
    Tyberg A, et al. Peroral endoscopic myotomy as salvation technique post-Heller: international experience. Dig Endosc. 2018;30:52–6.  https://doi.org/10.1111/den.12918.CrossRefPubMedGoogle Scholar
  142. 142.
    Yao S, Linghu E. Peroral endoscopic myotomy can improve esophageal motility in patients with achalasia from a large sample self-control research (66 patients). PLoS One. 2015;10:e0125942.  https://doi.org/10.1371/journal.pone.0125942.CrossRefPubMedPubMedCentralGoogle Scholar
  143. 143.
    Hu JW, et al. Peroral endoscopic myotomy for advanced achalasia with sigmoid-shaped esophagus: long-term outcomes from a prospective, single-center study. Surg Endosc. 2015;29:2841–50.  https://doi.org/10.1007/s00464-014-4013-9.CrossRefGoogle Scholar
  144. 144.
    Teitelbaum EN, et al. Symptomatic and physiologic outcomes one year after peroral esophageal myotomy (POEM) for treatment of achalasia. Surg Endosc. 2014;28:3359–65.  https://doi.org/10.1007/s00464-014-3628-1.CrossRefGoogle Scholar
  145. 145.
    Zhou PH, et al. Peroral endoscopic remyotomy for failed Heller myotomy: a prospective single-center study. Endoscopy. 2013;45:161–6.  https://doi.org/10.1055/s-0032-1326203.CrossRefPubMedGoogle Scholar
  146. 146.
    Swanstrom LL, et al. Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure. Ann Surg. 2012;256:659–67.  https://doi.org/10.1097/SLA.0b013e31826b5212.CrossRefPubMedGoogle Scholar
  147. 147.
    Shiwaku H. et al. Multicenter collaborative retrospective evaluation of peroral endoscopic myotomy for esophageal achalasia: analysis of data from more than 1300 patients at eight facilities in Japan. Surg Endosc. 2019.  https://doi.org/10.1007/s00464-019-06833-8.
  148. 148.
    Grimes KL, et al. Double-scope per oral endoscopic myotomy (POEM): a prospective randomized controlled trial. Surg Endosc. 2016;30:1344–51.  https://doi.org/10.1007/s00464-015-4396-2.CrossRefGoogle Scholar
  149. 149.
    Liu W. et al. Open peroral endoscopic myotomy for the treatment of achalasia: a case series of 82 cases. Dis Esophagus. 2019.  https://doi.org/10.1093/dote/doz052.
  150. 150.
    Chandan S. et al. Clinical efficacy of per-oral endoscopic myotomy (POEM) for spastic esophageal disorders: a systematic review and meta-analysis. Surg Endosc. 2019.  https://doi.org/10.1007/s00464-019-06819-6.
  151. 151.
    Kim WH, et al. Comparison of the outcomes of peroral endoscopic myotomy for achalasia according to manometric subtype. Gut Liver. 2017;11:642–7.  https://doi.org/10.5009/gnl16545.CrossRefPubMedPubMedCentralGoogle Scholar
  152. 152.
    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;33:886–94.  https://doi.org/10.1007/s00464-018-6356-0.CrossRefGoogle Scholar
  153. 153.
    Zhang W, Linghu EQ. Peroral endoscopic myotomy for type III achalasia of Chicago classification: outcomes with a minimum follow-up of 24 months. J Gastrointest Surg. 2017;21:785–91.  https://doi.org/10.1007/s11605-017-3398-x.CrossRefPubMedGoogle Scholar
  154. 154.
    Chen X, et al. Two-year follow-up for 45 patients with achalasia who underwent peroral endoscopic myotomy. Eur J Cardiothorac Surg. 2015;47:890–6.  https://doi.org/10.1093/ejcts/ezu320.CrossRefPubMedGoogle Scholar
  155. 155.
    Khashab MA, et al. International multicenter experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video). Gastrointest Endosc. 2015;81:1170–7.  https://doi.org/10.1016/j.gie.2014.10.011.CrossRefGoogle Scholar
  156. 156.
    Stavropoulos SN, et al. Per-oral endoscopic myotomy white paper summary. Surg Endosc. 2014;28:2005–19.  https://doi.org/10.1007/s00464-014-3630-7.CrossRefPubMedGoogle Scholar
  157. 157.
    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;29:3030–46.  https://doi.org/10.1007/s00464-014-4040-6.CrossRefGoogle Scholar
  158. 158.
    Kumbhari V, et al. Gastroesophageal reflux after peroral endoscopic myotomy: a multicenter case-control study. Endoscopy. 2017;49:634–42.  https://doi.org/10.1055/s-0043-105485.CrossRefGoogle Scholar
  159. 159.
    Kahrilas PJ, Katzka D, Richter JE. Clinical practice update: the use of per-oral endoscopic myotomy in achalasia: expert review and best practice advice from the AGA Institute. Gastroenterology. 2017;153:1205–11.  https://doi.org/10.1053/j.gastro.2017.10.001.CrossRefPubMedPubMedCentralGoogle Scholar
  160. 160.
    Rosati R, et al. Laparoscopic approach to esophageal achalasia. Am J Surg. 1995;169:424–7.PubMedCrossRefGoogle Scholar
  161. 161.
    Ancona E, et al. Esophageal achalasia: laparoscopic versus conventional open Heller-Dor operation. Am J Surg. 1995;170:265–70.PubMedCrossRefGoogle Scholar
  162. 162.
    Mitchell PC, et al. Laparoscopic cardiomyotomy with a Dor patch for achalasia. Can J Surg. 1995;38:445–8.PubMedGoogle Scholar
  163. 163.
    Swanstrom LL, Pennings J. Laparoscopic esophagomyotomy for achalasia. Surg Endosc. 1995;9:286–90; discussion 290–282.PubMedGoogle Scholar
  164. 164.
    Raiser F, et al. Heller myotomy via minimal-access surgery. An evaluation of antireflux procedures. Arch Surg. 1996;131:593–7; discussion 597–598.PubMedCrossRefGoogle Scholar
  165. 165.
    Morino M, Rebecchi F, Festa V, Garrone C. Laparoscopic Heller cardiomyotomy with intraoperative manometry in the management of oesophageal achalasia. Int Surg. 1995;80:332–5.PubMedGoogle Scholar
  166. 166.
    Robertson GS, Lloyd DM, Wicks AC, de Caestecker J, Veitch PS. Laparoscopic Heller’s cardiomyotomy without an antireflux procedure. Br J Surg. 1995;82:957–9.PubMedCrossRefGoogle Scholar
  167. 167.
    Bonavina L, Rosati R, Segalin A, Peracchia A. Laparoscopic Heller-Dor operation for the treatment of oesophageal achalasia: technique and early results. Ann Chir Gynaecol. 1995;84:165–8.PubMedGoogle Scholar
  168. 168.
    Delgado F, et al. Laparoscopic treatment of esophageal achalasia. Surg Laparosc Endosc. 1996;6:83–90.PubMedCrossRefGoogle Scholar
  169. 169.
    Hunter JG, Trus TL, Branum GD, Waring JP. Laparoscopic Heller myotomy and fundoplication for achalasia. Ann Surg. 1997;225:655–64; discussion 664–655.  https://doi.org/10.1097/00000658-199706000-00003.CrossRefPubMedPubMedCentralGoogle Scholar
  170. 170.
    Kjellin AP, Granqvist S, Ramel S, Thor KB. Laparoscopic myotomy without fundoplication in patients with achalasia. Eur J Surg. 1999;165:1162–6.  https://doi.org/10.1080/110241599750007702.CrossRefPubMedGoogle Scholar
  171. 171.
    Ackroyd R, Watson DI, Devitt PG, Jamieson GG. Laparoscopic cardiomyotomy and anterior partial fundoplication for achalasia. Surg Endosc. 2001;15:683–6.  https://doi.org/10.1007/s004640080037.CrossRefPubMedGoogle Scholar
  172. 172.
    Yamamura MS, Gilster JC, Myers BS, Deveney CW, Sheppard BC. Laparoscopic heller myotomy and anterior fundoplication for achalasia results in a high degree of patient satisfaction. Arch Surg. 2000;135:902–6.PubMedCrossRefGoogle Scholar
  173. 173.
    Patti MG, et al. Laparoscopic Heller myotomy and Dor fundoplication for achalasia: analysis of successes and failures. Arch Surg. 2001;136:870–7.PubMedCrossRefGoogle Scholar
  174. 174.
    Pechlivanides G, et al. Laparoscopic Heller cardiomyotomy and Dor fundoplication for esophageal achalasia: possible factors predicting outcome. Arch Surg. 2001;136:1240–3.PubMedCrossRefGoogle Scholar
  175. 175.
    Sharp KW, Khaitan L, Scholz S, Holzman MD, Richards WO. 100 consecutive minimally invasive Heller myotomies: lessons learned. Ann Surg. 2002;235:631–8; discussion 638–639.  https://doi.org/10.1097/00000658-200205000-00004.CrossRefPubMedPubMedCentralGoogle Scholar
  176. 176.
    Donahue PE, Horgan S, Liu KJ, Madura JA. Floppy Dor fundoplication after esophagocardiomyotomy for achalasia. Surgery. 2002;132:716–22; discussion 722–713.PubMedCrossRefPubMedCentralGoogle Scholar
  177. 177.
    Zaninotto G, et al. Etiology, diagnosis, and treatment of failures after laparoscopic Heller myotomy for achalasia. Ann Surg. 2002;235:186–92.  https://doi.org/10.1097/00000658-200202000-00005.CrossRefPubMedPubMedCentralGoogle Scholar
  178. 178.
    Luketich JD, et al. Outcomes after minimally invasive esophagomyotomy. Ann Thorac Surg. 2001;72:1909–12; discussion 1912–1903.PubMedCrossRefPubMedCentralGoogle Scholar
  179. 179.
    Decker G, et al. Gastrointestinal quality of life before and after laparoscopic heller myotomy with partial posterior fundoplication. Ann Surg. 2002;236:750–8; discussion 758.  https://doi.org/10.1097/00000658-200212000-00007.CrossRefPubMedPubMedCentralGoogle Scholar
  180. 180.
    Mineo TC, Ambrogi V. Long-term results and quality of life after surgery for oesophageal achalasia: one surgeon’s experience. Eur J Cardiothorac Surg. 2004;25:1089–96.  https://doi.org/10.1016/j.ejcts.2004.01.043.CrossRefPubMedPubMedCentralGoogle Scholar
  181. 181.
    Gockel I, Junginger T, Eckardt VF. Long-term results of conventional myotomy in patients with achalasia: a prospective 20-year analysis. J Gastrointest Surg. 2006;10:1400–8.  https://doi.org/10.1016/j.gassur.2006.07.006.CrossRefPubMedPubMedCentralGoogle Scholar
  182. 182.
    Wright AS, Williams CW, Pellegrini CA, Oelschlager BK. Long-term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia. Surg Endosc. 2007;21:713–8.  https://doi.org/10.1007/s00464-006-9165-9.CrossRefPubMedPubMedCentralGoogle Scholar
  183. 183.
    Khajanchee YS, Kanneganti S, Leatherwood AE, Hansen PD, Swanstrom LL. Laparoscopic Heller myotomy with Toupet fundoplication: outcomes predictors in 121 consecutive patients. Arch Surg. 2005;140:827–33; discussion 833–824.  https://doi.org/10.1001/archsurg.140.9.827.CrossRefPubMedPubMedCentralGoogle Scholar
  184. 184.
    Zaninotto G, et al. Randomized controlled trial of botulinum toxin versus laparoscopic heller myotomy for esophageal achalasia. Ann Surg. 2004;239:364–70.  https://doi.org/10.1097/01.sla.0000114217.52941.c5.CrossRefPubMedPubMedCentralGoogle Scholar
  185. 185.
    Csendes A, et al. Very late results of esophagomyotomy for patients with achalasia: clinical, endoscopic, histologic, manometric, and acid reflux studies in 67 patients for a mean follow-up of 190 months. Ann Surg. 2006;243:196–203.  https://doi.org/10.1097/01.sla.0000197469.12632.e0.CrossRefPubMedPubMedCentralGoogle Scholar
  186. 186.
    Ramacciato G, et al. The laparoscopic approach with antireflux surgery is superior to the thoracoscopic approach for the treatment of esophageal achalasia. Experience of a single surgical unit. Surg Endosc. 2002;16:1431–7.  https://doi.org/10.1007/s00464-001-9215-2.CrossRefPubMedPubMedCentralGoogle Scholar
  187. 187.
    Richards WO, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg. 2004;240:405–12; discussion 412–405.  https://doi.org/10.1097/01.sla.0000136940.32255.51.CrossRefPubMedPubMedCentralGoogle Scholar
  188. 188.
    Rawlings A, et al. Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial. Surg Endosc. 2012;26:18–26.  https://doi.org/10.1007/s00464-011-1822-y.CrossRefPubMedPubMedCentralGoogle Scholar
  189. 189.
    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;267:451–60.  https://doi.org/10.1097/SLA.0000000000002311.CrossRefGoogle Scholar
  190. 190.
    Vaezi MF, Baker ME, Achkar E, Richter JE. Timed barium oesophagram: better predictor of long term success after pneumatic dilation in achalasia than symptom assessment. Gut. 2002;50:765–70.  https://doi.org/10.1136/gut.50.6.765.CrossRefPubMedPubMedCentralGoogle Scholar
  191. 191.
    Roman S, et al. Partial recovery of peristalsis after myotomy for achalasia: more the rule than the exception. JAMA Surg. 2013;148:157–64.  https://doi.org/10.1001/2013.jamasurg.38.CrossRefPubMedPubMedCentralGoogle Scholar
  192. 192.
    Tustumi F, et al. Esophageal achalasia: a risk factor for carcinoma. A systematic review and meta-analysis. Dis Esophagus. 2017;30:1–8.  https://doi.org/10.1093/dote/dox072.CrossRefGoogle Scholar
  193. 193.
    Leeuwenburgh I, et al. Long-term esophageal cancer risk in patients with primary achalasia: a prospective study. Am J Gastroenterol. 2010;105:2144–9.  https://doi.org/10.1038/ajg.2010.263.CrossRefGoogle Scholar
  194. 194.
    Ravi K, Geno DM, Katzka DA. Esophageal cancer screening in achalasia: is there a consensus? Dis Esophagus. 2015;28:299–304.  https://doi.org/10.1111/dote.12196.CrossRefPubMedPubMedCentralGoogle Scholar
  195. 195.
    Harvey PR, et al. Incidence, morbidity and mortality of patients with achalasia in England: findings from a study of nationwide hospital and primary care data. Gut. 2019;68:790–5.  https://doi.org/10.1136/gutjnl-2018-316089.CrossRefPubMedPubMedCentralGoogle Scholar
  196. 196.
    Zaninotto G, et al. Long-term results (6–10 years) of laparoscopic fundoplication. J Gastrointest Surg. 2007;11:1138–45.  https://doi.org/10.1007/s11605-007-0195-y.CrossRefPubMedPubMedCentralGoogle Scholar
  197. 197.
    Zaninotto G, et al. Four hundred laparoscopic myotomies for esophageal achalasia: a single centre experience. Ann Surg. 2008;248:986–93.  https://doi.org/10.1097/SLA.0b013e3181907bdd.CrossRefPubMedPubMedCentralGoogle Scholar
  198. 198.
    Bonatti H, et al. Long-term results of laparoscopic Heller myotomy with partial fundoplication for the treatment of achalasia. Am J Surg. 2005;190:874–8.  https://doi.org/10.1016/j.amjsurg.2005.08.012.CrossRefPubMedPubMedCentralGoogle Scholar
  199. 199.
    Costantini M, et al. The laparoscopic Heller-Dor operation remains an effective treatment for esophageal achalasia at a minimum 6-year follow-up. Surg Endosc. 2005;19:345–51.  https://doi.org/10.1007/s00464-004-8941-7.CrossRefPubMedGoogle Scholar
  200. 200.
    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;20:956–60.  https://doi.org/10.1097/MEG.0b013e3282fbf5e5.CrossRefGoogle Scholar
  201. 201.
    Ngamruengphong S, et al. Efficacy and safety of peroral endoscopic myotomy for treatment of achalasia after failed Heller myotomy. Clin Gastroenterol Hepatol. 2017;15:1531–1537.e1533.  https://doi.org/10.1016/j.cgh.2017.01.031.CrossRefPubMedPubMedCentralGoogle Scholar
  202. 202.
    Legros L, et al. Long-term results of pneumatic dilatation for relapsing symptoms of achalasia after Heller myotomy. Neurogastroenterol Motil. 2014;26:1248–55.  https://doi.org/10.1111/nmo.12380.CrossRefPubMedGoogle Scholar
  203. 203.
    Rakita S, Villadolid D, Kalipersad C, Thometz D, Rosemurgy A. Outcomes promote reoperative Heller myotomy for symptoms of achalasia. Surg Endosc. 2007;21:1709–14.  https://doi.org/10.1007/s00464-007-9226-8.CrossRefPubMedPubMedCentralGoogle Scholar
  204. 204.
    Grotenhuis BA, et al. Reoperation for dysphagia after cardiomyotomy for achalasia. Am J Surg. 2007;194:678–82.  https://doi.org/10.1016/j.amjsurg.2007.01.035.CrossRefPubMedPubMedCentralGoogle Scholar
  205. 205.
    Patel DA, Vaezi MF. Refractory achalasia: is POEM changing the paradigm? Clin Gastroenterol Hepatol. 2017;15:1504–6.  https://doi.org/10.1016/j.cgh.2017.04.032.CrossRefPubMedGoogle Scholar
  206. 206.
    Hoogerwerf WA, et al. Pharmacologic therapy in treating achalasia. Gastrointest Endosc Clin N Am. 2001;11:311–23.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Section of Gastroenterology, Hepatology, and NutritionCenter for Swallowing and Esophageal Disorders, Digestive Disease Center, Vanderbilt University Medical CenterNashvilleUSA

Personalised recommendations