Advantages and Disadvantages of Different Modalities of Treatment of Achalasia Cardia
Therapy | Advantage | Disadvantage |
---|---|---|
Surgical myotomy (LHM) | Long-term durability Procedure time - 90 min Excellent response rate (90%–97% with 3%–10% recurrent dysphagia) |
General anaesthesia required Higher recovery time - hospital stay for 2–3 days Cost GER (2%–26%): minimized with fundoplication |
PD | Most effective non-surgical option Durability range - 2–5 yr Short procedure Short recovery time Can be done on demand |
Risk of perforation (1%–5%) Advised only in surgically fit candidates (who can be taken for surgery if complication occurs) Response rate poor in young male (< 40 yr), type III and I achalasia (33% and 63%, respectively) Relapse in 33%–50% patients |
POEM | Long-term durability comparable to LHM Minimally invasive - lesser hospital stay Longer myotomy - useful in type III achalasia and other motility disorders |
Limited availability and technically demanding High incidence of GER (20%–54%) - can be reduced by concurrent endoscopic fundoplication |
Medical therapy | Can be taken as on demand therapy Minimal risk for candidates with high surgical risk |
Least effective treatment option Short lasting effect and continuous treatment required High incidence of adverse effects of medications |
Esophagectomy | For end stage disease For treatment resistant achalasia |
High morbidity and mortality May develop anastomotic site strictures Chronic vomiting observed in some patients |
BT injection | Good option for high surgical risk candidates Short procedure time |
Durability of 6–12 mo Submucosal injection precludes future definitive therapy |
LHM, laparoscopic Heller’s myotomy; GER, gastroesophageal reflux; PD, pneumatic dilatation; POEM, per-oral endoscopic myotomy; BT, botulinum toxin.