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The SAGES Manual of Flexible Endoscopy pp 207–221Cite as

Achalasia Management: Botox, Dilation, Peroral Esophageal Myotomy (POEM), Peroral Pyloromyotomy (POP)

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Abstract

Achalasia is an esophageal motility disorder characterized by a non-relaxing lower esophageal sphincter and absent or significantly altered peristalsis. The underlying cause of most cases is unknown, with a small minority secondary to infectious, genetic, or obstructive etiologies. There is no cure. Palliative treatments include medical therapies and disruption of the lower esophageal sphincter. Botulinum toxin injection provides effective short-term relief but often lacks durability, thus lending itself to highly comorbid patients or in select diagnostic scenarios. Serial pneumatic dilations offer excellent symptom relief and durability, with rates comparable to surgical myotomy in appropriately selected patients. Peroral esophageal myotomy (POEM) is an established endoscopic therapy that offers robust dysphagia relief with minimized surgical morbidity. Patients who require reoperative achalasia surgery are at high risk for vagal nerve injury and gastroparesis. Emerging endoscopic therapies, such peroral pyloromyotomy (POP), may be an effective tool in this challenging patient population.

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Abbreviations

EGD:

Esophagogastroduodenoscopy

EGJ:

Esophagogastric junction

G-POEM:

Gastric peroral endoscopic myotomy

GERD:

Gastroesophageal reflux disease

HRM:

High-resolution manometry

LES:

Lower esophageal sphincter

PD:

Pneumatic dilation

POEM:

Peroral esophageal myotomy

POP:

Peroral pyloromyotomy

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Authors and Affiliations

  1. Northwestern Memorial Hospital, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Ryan A. J. Campagna & Eric S. Hungness

Authors
  1. Ryan A. J. Campagna
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  2. Eric S. Hungness
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Correspondence to Ryan A. J. Campagna .

Editor information

Editors and Affiliations

  1. University of Iowa, Iowa City, IA, USA

    Peter Nau

  2. Penn State Milton S. Hershey Medical Cen, Hershey, PA, USA

    Eric M. Pauli

  3. University of California, San Diego, La Jolla, CA, USA

    Bryan J. Sandler

  4. Dartmouth–Hitchcock Medical Center, Lebanon, NH, USA

    Thadeus L. Trus

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© 2020 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)

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Campagna, R.A.J., Hungness, E.S. (2020). Achalasia Management: Botox, Dilation, Peroral Esophageal Myotomy (POEM), Peroral Pyloromyotomy (POP). In: Nau, P., Pauli, E., Sandler, B., Trus, T. (eds) The SAGES Manual of Flexible Endoscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-23590-1_13

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  • DOI: https://doi.org/10.1007/978-3-030-23590-1_13

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-23589-5

  • Online ISBN: 978-3-030-23590-1

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