Endoscopic Myotomy for Non-achalasia Esophageal Disorders

Abstract

As the experience in endoscopic esophageal myotomy grows, the consideration for its application in non-achalasia motility disorders when more conservative measures have failed is becoming more reasonable. The classification of “non-achalasia” esophageal disorders represents a host of various manometric features that may not fit into a single category quite as neatly as achalasia does. Analysis of such spastic and hyper-contractile disorders is thereby more complicated. In this chapter, we will focus on manometric evaluation of non-achalasia disorders that can best be described along a spectrum of abnormal contractility that may be amenable to myotomy. The idea that the area of abnormal contractility, by virtue of esophageal spasm or extreme contraction vigor, causes clinical symptoms and that impairment of this activity through myotomy could improve a patient’s quality of life will be explored. Surgical tips and tricks unique to myotomy for non-achalasia esophageal disorders will be discussed.