From the Guidelines
The preferred surgical treatment for type I and type II achalasia should be based on shared decision making, considering patient and disease characteristics, patient preferences, and local expertise, while POEM is the preferred treatment for type III achalasia. When considering treatment options for achalasia, it is essential to differentiate between the subtypes, as treatment outcomes vary among them 1.
- Type I and Type II achalasia can be effectively treated with POEM, LHM, or PD, with the decision among these treatment modalities depending on various factors 1.
- Type III achalasia, characterized by spastic body contractions, is best treated with POEM, which allows for unlimited proximal extension of myotomy 1. Key considerations in treatment selection include:
- Patient factors, such as age, comorbidities, and body habitus
- Disease characteristics, including the presence of esophageal outflow obstruction and esophageal aperistalsis
- Local expertise and availability of treatment options
- Patient preferences, including the potential risks and benefits of each treatment modality 1. It is crucial to weigh the advantages and disadvantages of each treatment option, including the potential for symptom relief, risk of complications, and impact on quality of life 1.
From the Research
Treatment Options for Achalasia
The preferred surgical treatment for achalasia depends on the type of achalasia and the patient's condition. The following are some treatment options:
- Laparoscopic Heller myotomy (LHM) with partial fundoplication is considered the gold standard treatment for achalasia, especially for type 1 and type 2 achalasia 2, 3, 4.
- Peroral endoscopic myotomy (POEM) is a viable alternative to LHM and has shown excellent short-term safety and efficacy in relieving symptoms, especially for type 3 achalasia 2, 5, 6.
- Pneumatic dilation is also an effective treatment option for achalasia, especially for type 1 and type 2 achalasia 4, 6.
Type-Specific Treatment
- Type 1 achalasia: LHM, POEM, or pneumatic dilation can be used as treatment options 4, 6.
- Type 2 achalasia: LHM, POEM, or pneumatic dilation can be used as treatment options 4, 6.
- Type 3 achalasia: POEM is the current method of choice, but LHM and pneumatic dilation can also be used 6.
Considerations for Treatment Selection
- The choice of treatment depends on the patient's condition, age, and overall health 4.
- LHM with partial fundoplication is a safe and effective treatment option, but it may not be suitable for all patients, especially those with advanced achalasia findings 4.
- POEM is a less invasive procedure, but it may have a higher risk of postoperative complications, such as pathologic reflux 2, 5.
- Pneumatic dilation is a simple and effective treatment option, but it may have a lower long-term success rate compared to LHM and POEM 4.