Achalasia: what to do in the face of failures of Heller myotomy

• Published in: Annals of the New York Academy of Sciences Vol. 1481; no. 1; pp. 236 - 246
• Main Authors: Felix, Valter N., Murayama, Kenric M., Bonavina, Luigi, Park, Moo In
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-12-2020
• Subjects: Achalasia; Botulinum toxin; Endoscopy; Esophageal Achalasia - diagnostic imaging; Esophageal Achalasia - physiopathology; Esophageal Achalasia - surgery; Esophageal Sphincter, Lower - diagnostic imaging; Esophageal Sphincter, Lower - physiopathology; Esophageal Sphincter, Lower - surgery; Esophagectomy; Esophagoscopy; Esophagus; Heller Myotomy - adverse effects; Humans; Manometry; pneumatic dilation; redo esophageal myotomy; Signs and symptoms; therapeutic methods for achalasia; Toxins; esophagectomy; POEM; achalasia; pneumatic dilation; therapeutic methods for achalasia; redo esophageal myotomy
• ISSN: 0077-8923; 1749-6632
• DOI: 10.1111/nyas.14440

Achalasia is a primary motility disorder of the esophagus, and while there are several treatment options, there is no consensus regarding them. When therapeutic intervention for achalasia fails, a careful evaluation of the cause of the persistent or recurrent symptoms using upper endoscopy, esophageal manometry, and contrast radiologic studies is required to understand the cause of therapy failure and guide plans for subsequent treatment. Options for reintervention are the same as for primary intervention and include pneumatic dilation, botulinum toxin injection, peroral endoscopic myotomy, or redo esophageal myotomy. When reintervention fails or if the esophagus is not amenable to intervention and the disease is considered end‐stage, esophagectomy is the last option to manage recurrent achalasia.