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Achalasia: what to do in the face of failures of Heller myotomy
Author(s) -
Felix Valter N.,
Murayama Kenric M.,
Bonavina Luigi,
Park Moo In
Publication year - 2020
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1111/nyas.14440
Subject(s) - achalasia , medicine , myotomy , esophageal motility disorder , esophagus , heller myotomy , surgery , botulinum toxin , endoscopy
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.