Surgical Treatment Of Esophageal Achalasia

Patients with suspected achalasia should undergo a barium esophagram, an upper endoscopy, and esophageal manometry to confirm the diagnosis. (Moderate, Strong)

Pharmacotherapy plays a very limited role in the treatment of achalastic patients and should be used in very early stages of the disease, temporarily prior to more definitive treatments, or for patients who fail or are not candidates for other treatment modalities. (High, Strong)

Botulinum toxin injection can be administered safely, but its effectiveness is limited especially in the long term. It should be reserved for patients who are poor candidates for other more effective treatment options such as surgery or dilation. (High, Strong)

Among nonoperative treatment techniques endoscopic dilation is the most effective for dysphagia relief in patients with achalasia but is also associated with the highest risk of complications. It should be considered in selected patients who refuse surgery or are poor operative candidates. (High, Strong)

The use of esophageal stents cannot be recommended for the treatment of achalasia. (Low, Strong)