ASGE Esophagology: Tailoring Management from Testing to Treatment (Live and Virtual) | July 2022-CASE Based Discussion Session 3

Video Transcription

Video Summary

In this video, Dr. John Pandolfino discusses the topic of recurrent symptoms after treatment for achalasia. He highlights the importance of understanding achalasia subtypes and avoiding mistakes such as aggressive myotomy or not appreciating the anatomy or biomechanics of bolus transport. Dr. Pandolfino also emphasizes the importance of considering psychological distress in these patients. He discusses the different subtypes of achalasia, particularly focusing on the importance of isobaric pressurization pattern for predicting outcome. He shares a case presentation of a patient who had previous treatments but still had symptoms, demonstrating the significance of anatomy when making treatment decisions. Dr. Pandolfino presents an algorithm for evaluating these patients, emphasizing the use of time-barium esophagram as an initial test, followed by endoscopy and esophageal high-resolution manometry if necessary. He also discusses the concept of blown-out myotomy and the need to rethink myotomy length in order to avoid this complication. Dr. Pandolfino concludes by discussing the limitations of the Eckardt score and the importance of personalized approaches to treatment. <br /><br />No credits were granted in the video.

Keywords

recurrent symptoms

achalasia

subtypes

anatomy

biomechanics

psychological distress