Different Endoscopic Treatment Options in the Management of Achalasia

Abstract

In this article, we showed the optimal examination schedule in patients with suspected achalasia. The diagnostic algorithm of achalasia included X-ray, multispiral computed tomography (MSCT) of the chest and upper abdomen and endoscopic examination methods. All these methods allowed for establishing the exact diagnosis and precise stage of the disease. The most common classification for achalasia staging in the Russian Federation is the classification proposed by Petrovskiy B. V. in 1962 which is based on the interpretation of X-ray imaging results because of their simplicity and availability. In this study we also showed different treatment options such as an endoscopic balloon pneumatic dilation used to relieve the obstruction by mechanical disrupting, botulinum toxin injection directed to reduce pressure of the lower esophageal sphincter, minimally invasive interventions with pharmacological therapy, and surgical treatment for patients with IV stage of the disease that may benefit in 98,2% of those patients. Additionally we showed clinical results of an absolutely new treatment method of endoscopic managing achalasia in the Russian Federation: oral esophageal myotomy (POEM) used in our clinic since 2014. It is a promising and minimally invasive option for treating achalasia. However, it still requires more data and assessment of clinical efficacy. Refs 19. Figs 8.