Related Experiment Video
Updated: Feb 24, 2026
Robotic Myotomy and Partial Fundoplication for Achalasia
Published on: August 11, 2023
POEM and the management of achalasia
1Department of Gastroenterology, University College London Hospitals, London, UK.
Insights
Achalasia, a rare esophageal disorder, causes swallowing difficulties. Treatments like balloon dilation and Heller
Area of Science:
- Gastroenterology
- Esophageal Motility Disorders
Background:
- Achalasia is a rare esophageal motility disorder characterized by dysphagia and regurgitation.
- Diagnosis involves endoscopy, barium swallow, and manometry, with high-resolution manometry leading to the Chicago Classification.
- This classification aids in understanding achalasia subtypes, influencing prognosis and therapy.
Purpose of the Study:
- To review the current understanding and treatment of achalasia.
- To evaluate the efficacy and durability of various achalasia treatments.
- To discuss the expanding role of Per-oral Endoscopic Myotomy (POEM).
Main Methods:
- Review of diagnostic methods including endoscopy, barium swallow, and esophageal manometry.
- Analysis of treatment outcomes for botulinum toxin, pneumatic balloon dilatation, and laparoscopic Heller's myotomy.
- Evaluation of Per-oral Endoscopic Myotomy (POEM) efficacy and safety.
Main Results:
- Pneumatic balloon dilatation and laparoscopic Heller's myotomy offer similar, durable outcomes, though success may decrease over time.
- Botulinum toxin provides short-term efficacy.
- POEM demonstrates comparable effectiveness, safety, and durability to established treatments, despite a lack of randomized controlled trials.
Conclusions:
- Achalasia management has evolved with improved diagnostic tools and therapeutic options.
- POEM is an effective and durable treatment for achalasia and is being considered for other esophageal motility disorders.
- Further randomized controlled trials are needed to solidify POEM's place in achalasia treatment guidelines.
Abstract:
Achalasia is a rare oesophageal motility disorder predominantly causing dysphagia and regurgitation of food and fluids. Diagnosis is made typically after a combination of tests including endoscopy, barium swallow and oesophageal manometry. The advent of high-resolution manometry has led to the Chicago Classification which divided achalasia into three types. This improved the understanding of presentation, prognosis and might also help tailor therapy. Botulinum toxin has been shown to have good, but short-term efficacy. The predominant treatments include pneumatic balloon dilatation and laparoscopic Heller's myotomy, both of which have similar and durable outcomes, although the success of both reduces with time. Per-oral endoscopic myotomy (POEM) has been shown to be as effective, safe and durable as earlier treatments for achalasia; however, randomised controlled trials are lacking. Indications for POEM are expanding to other hypercontractile motility disorders of the oesophagus.
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