ASGE Endoscopy Live: Management of Achalasia (On-Demand) | April 2023-Lecture - John Pandolfino Challenging Cases in Achalasia POEM

Lecture - John Pandolfino Challenging Cases in Achalasia POEM

Video Transcription

Video Summary

In this video, Dr. John Pandolfino from Northwestern University discusses challenging cases of achalasia with POEM (peroral endoscopic myotomy) and the approach to patients with difficult presentations. He emphasizes the heterogeneity of achalasia and the need for a precision approach to tailor therapy based on the specific abnormalities driving abnormal function in each patient. Dr. Pandolfino discusses common mistakes made in evaluating these patients, such as not understanding the subtypes of EGJ (esophagogastric junction) outflow obstruction, not appreciating anatomy, and not considering the interplay of psychological distress on outcome. He also discusses the evolution of the Chicago classification and the importance of diagnostic tests such as timed barium esophagram and FLIP (functional lumen imaging probe) to inform treatment decisions and evaluate post-treatment outcomes. Dr. Pandolfino concludes by emphasizing the need for standardizing the approach to FLIP and considering the whole pattern of esophageal function in assessing treatment effectiveness.

Keywords

achalasia

POEM

EGJ outflow obstruction

Chicago classification

FLIP

esophageal function