This ASG video tip is brought to you by an educational grant from Braintree, a part of Cibela Pharmaceuticals, makers of SUTAB. Pneumatic dilation, by the way, as you can see, I cannot make my mind where to put the morbidly obese category. I have listed them everywhere, and this will be a good point to discuss during our panel. But certainly in older patients, I tend to favor that, or in patients that have recurrent symptoms after heller myotomy or POEM, although you can certainly redo both the heller myotomy and the POEM. Pneumatic dilation then comes into play as one of the primary modalities. And then finally, you have Botox. Patients with severe comorbidities, I mean, we have patients referred for POEM with pulmonary artery pressures of 70 millimeters of mercury, and putting them through roughly what is a one-hour procedure under general anesthesia, probably not a good idea. Patients that are unable to stop anticoagulation fresh after a stroke or placement of cardiac stent, there is nothing wrong to give them Botox to buy some time. Advanced age, and in pregnant women that happen to be diagnosed with alakalasia during pregnancy, again, you can tread some water until some more definitive therapy can be applied after delivery.

treatment options

pneumatic dilation

Botox injections

individual circumstances

medical history