Historical Perspective: History of the Surgical Management of Achalasia

Abstract

Achalasia is a primary motility disorder of the esophagus with an incidence of 1 in 100,000 annually. It is best characterized by the existence of both: absence of esophageal peristalsis and failure of relaxation of the lower esophageal sphincter (LES). This is a progressive disease that if left untreated can evolve to a completely nonfunctional megaesophagus. Over the past century, the development of fluoroscopy, flexible endoscopy, and more recently high-resolution manometry have transformed our understanding of achalasia. The introduction of minimally invasive surgery for achalasia in 1991 and the recent introduction of POEM (Per Oral Endoscopic Myotomy) in 2009 have revolutionized the treatment of achalasia and are now the most commonly utilized therapeutic modalities. Furthermore, in the digital era, patients with rare diseases commonly seek information about their condition and direct their own care. Therefore, patients, who in the past might have been told to have pneumatic dilations instead of invasive abdominal or thoracic surgery, now actively seek – often by Internet searches – minimally invasive surgical or endoscopic treatment for their disease.