ASGE Esophagology: Tailoring Management from Testing to Treatment (On-Demand) | July 2022-Individualizing Management of Achalasia

Video Transcription

Video Summary

In this video, Dr. Peter Dragunov, a professor of medicine at the University of Florida, discusses the management of achalasia. He starts by emphasizing the importance of securing a diagnosis before determining the appropriate therapy. He notes that guidelines for achalasia management exist, with various treatment options available, including pneumatic dilation, laparoscopic heller myotomy, Botox, and peroral endoscopic myotomy (POEM). Dr. Dragunov discusses the advantages and disadvantages of each treatment. He explains that while Botox is easy to administer, its effect is short-lived and can complicate the diagnostic process. Pneumatic dilation is less invasive and effective, but may require serial treatments and carries a risk of perforation. Laparoscopic heller myotomy is a durable option, but can cause reflux and has a higher complication rate. POEM is a minimally invasive procedure with a shorter recovery time, but can also lead to reflux. Dr. Dragunov suggests that POEM is emerging as the preferred first-line therapy for achalasia, particularly for patients with type 3 achalasia or a history of upper abdominal surgeries. He also discusses specific patient categories where each treatment modality may be suitable. Dr. Dragunov advocates for a tailored approach to achalasia management based on individual patient characteristics and preferences. He suggests the need for further research and refinement of treatment techniques and discusses the potential role of additional procedures like fundoplication or transoral incisionless fundoplication (TIF) in combination with POEM. Although laparoscopic heller myotomy, pneumatic dilation, and Botox still have their place in achalasia management, Dr. Dragunov concludes that POEM is increasingly becoming the preferred first-line therapy.

Asset Subtitle

Dr. Peter Draganov

Keywords

achalasia management

diagnosis

treatment options

POEM

first-line therapy