Achalasia Procedures //

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The Best Results Are Dependent on a Successful First Intervention

POEM

Per Oral Myotomy (Endoscopic) |

This procedure uses general anesthesia and intubation, lasting about 1.5 hours. Hospital stay is usually 1 day, followed by a 3-month course of anti-reflux medications, after which we will evaluate reflux evidence.

Recovery mirrors the Heller myotomy, and diet progresses as tolerated. The common symptom of swallowing difficulty from achalasia typically resolves, though long-term data is lacking.
Reflux occurs in 40-80% of cases, often requiring lifelong anti-reflux medications or surgical intervention.
This method is crucial in managing achalasia; patients are candidates for both procedures, but the robotic approach generally has better outcomes and reflux rates due to its anti-reflux component.
We consider this a valuable procedure to prevent re-operative Heller myotomy, using it as a third-line therapy in complex cases.

Balloon Dilation

Endoscopic Balloon Dilation |

This procedure requires general anesthesia and intubation, similar to robotic Heller and PO, and usually lasts 30-45 minutes. Patients typically go home the same day with a 3-month course of anti-reflux medications, after which reflux will assessed. Recovery is faster than the other procedures, and swallowing difficulties generally resolve after three dilations with larger balloons. However, reflux occurs in 40-80% of cases, often requiring lifelong medication further surgery. This procedure is considered a second-line therapy for achalasia after initial surgery complications, with complication rates around 3-4%.

Recommended Algorithm for Best Results |

Algorithm and Comparison

Procedure Comparison |