Endoscopic Management of Achalasia: Botulinum Toxin and Pneumatic Dilation

  • Michael F. VaeziEmail author
  • Brian M. Lappas


Achalasia is the most common primary motility disorder of the esophagus and is characterized by impaired relaxation of the lower esophageal sphincter (LES) and absent peristalsis of the esophageal body during deglutition. It can cause significant morbidity with symptoms of dysphagia, regurgitation, chest pain, and weight loss. As there is no cure for achalasia, treatments should aim to relieve symptoms and prevent disease progression. Two of the most common endoscopic treatment options are botulinum toxin injection and pneumatic dilation. Botulinum toxin injection is an excellent option for elderly or high-risk surgical patients although repeat injections are often needed after 1 year. Pneumatic dilation is the most effective nonoperative treatment option and provides excellent symptom relief up to 10 years. Both methods have low complication rates, and patients may be discharged after a short period of observation.


Achalasia Botulinum toxin Pneumatic dilation Endoscopy Endoscopic dilation Botox injection Esophageal dysmotility Dysphagia 


Conflict of Interest

Dr. Vaezi has a research grant from Sandhill Scientific, Inc. (Denver, Co, USA). Dr. Lappas has no COI.


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Copyright information

© SAGES 2019

Authors and Affiliations

  1. 1.Division of Gastroenterology, Hepatology and NutritionVanderbilt University Medical CenterNashvilleUSA
  2. 2.Department of Internal MedicineVanderbilt University Medical CenterNashvilleUSA

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