Expert Commentary: Laparoscopic Versus Endoscopic Myotomy for Achalasia

  • Ezra N. Teitelbaum
  • Lee L. Swanstrom


Achalasia is the most common primary esophageal motility disorder, resulting from an immune-mediated loss of neurons of the myenteric plexus of the esophagus. This neuronal death causes a failure of esophagogastric junction (EGJ) relaxation and esophageal body peristalsis with swallowing, leading to symptoms of dysphagia, regurgitation, chest pain, and weight loss. Unfortunately, there is no therapy that can restore normal EGJ and esophageal body function in patients with achalasia. Current treatment modalities seek to palliate symptoms by decreasing the resting tone of the EGJ, which allows for passive transit of food boluses into the stomach. Medications are generally ineffective in producing more than a transient and minimal improvement in symptoms, and therefore procedural interventions that mechanically disrupt the muscle fibers of the lower esophageal sphincter (LES) form the mainstay of modern treatment.


Endoscopic myotomy Achalasia Endoscopic pneumatic dilation Laparoscopic Heller myotomy Peroral endoscopic myotomy POEM 


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Copyright information

© SAGES 2019

Authors and Affiliations

  • Ezra N. Teitelbaum
    • 1
  • Lee L. Swanstrom
    • 2
  1. 1.Northwestern UniversityChicagoUSA
  2. 2.The Oregon ClinicPortlandUSA

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