Achalasia: Surgery Versus Per-Oral Endoscopic Myotomy

Sadia Tasnim; Siva Raja; Monisha Sudarshan

doi:10.1016/j.thorsurg.2023.01.007

Achalasia: Surgery Versus Per-Oral Endoscopic Myotomy

Thorac Surg Clin. 2023 May;33(2):135-140. doi: 10.1016/j.thorsurg.2023.01.007. Epub 2023 Feb 26.

Authors

Sadia Tasnim¹, Siva Raja², Monisha Sudarshan³

Affiliations

¹ Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Thoracic Surgery, Thoracic and Cardiovascular Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail Code J4-1, Cleveland, OH 44195, USA. Electronic address: https://twitter.com/_SadiaTasnim.
² Thoracic Surgery, Thoracic and Cardiovascular Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail Code J4-1, Cleveland, OH 44195, USA.
³ Thoracic Surgery, Thoracic and Cardiovascular Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail Code J4-1, Cleveland, OH 44195, USA. Electronic address: [email protected].

PMID: 37045482
DOI: 10.1016/j.thorsurg.2023.01.007

Abstract

Approaches to achalasia include non-operative and operative techniques with Heller Myotomy and Per-Oral Endoscopic Myotomy (POEM) at the forefront of palliative strategies. Given the diverse subtypes and the time-dependent failure pattern for achalasia, there is no standard approach. We elect for a POEM for type III achalasia, poor functional status, hostile abdomen, and salvage after the previous myotomy. A Heller myotomy is elected over a POEM for type II achalasia, presence of diverticulum, and hiatal hernia. As long-term outcomes become available, an optimal customized strategy will become clearer.

Keywords: Achalasia; Dor fundoplication; Heller myotomy; POEM.

Publication types

Review

MeSH terms

Esophageal Achalasia* / surgery
Heller Myotomy* / methods
Hernia, Hiatal*
Humans
Myotomy*
Natural Orifice Endoscopic Surgery* / methods
Treatment Outcome