ENDOSCOPIC TREATMENT FOR ACHALASIA

Achalasia of oesophagus is a condition where the lower oesophageal sphincter (LES) is dysfunctional leading to altered motility of the oesophagus. The LES becomes very tight, not allowing solid food to pass down easily into the stomach. This leads to patients unable to eat and drink normally leading to weight loss and malnourishment. Patients also present with recurrent vomiting, and bad breadth due to food stasis in the oesophagus. It is also very important to rule out cancer of the distal oesophagus, and the doctor will advice accordingly.

Endoscopically, there are two treatments offered:

  1. Endoscopic balloon dilatation therapy
  2. 2. Per Oral Endoscopic Myomectomy (POEM)

 

Treatment

Endoscopically, there are two treatments offered:

  1. Endoscopic balloon dilatation therapy:

Once the diagnosis of achalasia is confirmed, the doctor will put down an endoscope through the mouth to the site of LES. A balloon is then placed across the sphincter, and gradually dilated with saline to a certain pressure enough to disrupt the muscle fibres of the LES. It offers temporary relief, and may need repeated attempts to give symptomatic relief. It is not a permanent solution, and the patient will end up needing a POEM or laparoscopic surgery to address it.

  1. Per Oral Endoscopic Myomectomy (POEM):

In POEM, the surgeon carries out the procedure via the endoscope introduced through the mouth. Using specialised instruments, the surgeon makes a small cut on the inner lining of the esophagus and creates a tunnel under the mucosal layer all the way up to the tight lower esophageal sphincter. The LES is then divided using a small knife via the endoscope, and the mucosal incision in the esophagus higher above is closed with clips. The patient has a check endoscopy and dye swallowing test the following day to confirm no side effects from the procedure.  The patient is discharged after 1 day and can resume normal diet. Currently, POEM has equivalent results to laparoscopic surgery, and remains scarless. There is a slightly higher risk of reflux, and the advice would be appropriately given.

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