Minimally Invasive Treatment of Achalasia

Achalasia is a rare disease of esophageal motility marked by absent peristalsis and insufficient relaxation of the lower esophageal sphincter. Treatment is palliative and aimed at improving symptoms. The management ranges from medical therapy to endoscopic and surgical interventions, with refractory end stage disease necessitating permanent enteral feeding tube or an esophagectomy. A Heller myotomy has been the main stay of treatment for over a century; a minimally invasive approach is the current standard of care because of its low risk and durable improvement in quality of life for these patients. For the past decade, an endoscopic option known as per oral endoscopic myotomy (POEM) has been increasingly performed and shows comparative symptom relief, offers an incisionless approach, and is the preferred procedure for a certain subtype of achalasia. Here we will detail the diagnosis, workup, and treatment options for this disease.