ASGE Annual Postgraduate Course: Clinical Challenges and Real-Time Decision Making in GI Endoscopy (Live and Virtual) | May 2023-ASGE Guideline on the Management of Achalasia

Pdf Summary

The ASGE guideline on the management of achalasia provides evidence-based recommendations for the treatment of achalasia, focusing on peroral endoscopic myotomy (POEM), botulinum toxin injection, pneumatic dilation, and laparoscopic Heller myotomy. POEM is the preferred treatment for type III achalasia, with success rates of 92-100% and lower risk of adverse events compared to laparoscopic Heller myotomy. Botulinum toxin injection, pneumatic dilation, and laparoscopic Heller myotomy have success rates of 77%, 83%, and 87.7% respectively. POEM has higher clinical success rates than pneumatic dilation, and laparoscopic Heller myotomy and POEM produce similar outcomes. Treatment choice should be individualized based on patient preferences, clinical considerations, and available resources. Current studies are comparing POEM with laparoscopic Heller myotomy and anterior vs posterior POEM. Pneumatic dilation is cost-effective in the short-term, but myotomy is more cost-effective in the long-term. The guideline recommends considering patient preference, achalasia type, and local expertise in choosing treatment options. Botulinum toxin injection is not a definitive therapy, and patients with failed myotomy may consider pneumatic dilation or redo myotomy. POEM carries a higher risk of post-procedure reflux compared to pneumatic dilation and laparoscopic Heller myotomy.

Meta Tag

Disease Achalasia'

Instrument & Accessory Used Pneumatic Dilation Balloon

Instrument & Accessory Used Endolumenal Imaging Probe

Organ & Anatomy Esophagus

Procedure EGD

Procedure Peroral Endoscopic Myotomy (POEM)

Procedure Botox Injection

Procedure Barium Esophagram

Procedure Laparoscopic Heller Myotomy

Procedure Esophageal Manometry

Procedure Pnuematic Dilation

Keywords

ASGE guideline

management of achalasia

peroral endoscopic myotomy

botulinum toxin injection

pneumatic dilation

laparoscopic Heller myotomy

type III achalasia

success rates

adverse events

clinical success rates