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Chad J. Cooper, Sarmad Said
(Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, USA)
Med Sci Rev 2014; 1:7-14
Achalasia is a neurodegenerative motility disorder of the esophagus, characterized by the failure of the lower esophageal sphincter to relax and aperistalsis of the esophageal body. Current standard procedures for achalasia include pneumatic balloon dilation or surgical myotomy. However, these options are limited in their effectiveness and long term efficacy. Fortunately in recent years, advanced therapeutic endoscopy has developed peroral endoscopic myotomy (POEM), which has become an alternative in the treatment of achalasia. Several studies have been done to determine the specific anatomic and physiologic effects of POEM and whether these patients achieved good symptomatic benefits without complications. A few studies have assessed the effectiveness and feasibility of POEM versus myotomy. In addition, a few reports have investigated whether POEM is a feasible alternative after other invasive procedures have been done and failed to improve dysphagia. The majority of studies demonstrate that POEM is a feasible procedure that provides great results such as less procedural complications, better postoperative healing and symptomatic relief of dysphagia in the short term. Gastroesophageal reflux was noted to occur after POEM in a few patients but the majority of them were well controlled on a daily dose of PPI. Further prospective randomized trials are required to compare the effectiveness of POEM with current treatment modalities and to establish its long-term effects for the management of achalasia. POEM is a novel therapeutic approach that is safe, technically feasible and has excellent symptomatic improvement in patients with esophageal achalasia.
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Keywords: Deglutition Disorders, Endoscopy, Esophageal Achalasia