Esophageal achalasia (Achalasia) causes the esophagus to be unable to normally transport food and liquids to the stomach. Endoscopic treatment for achalasia without surgery is therefore a treatment option that helps restore a good quality of life once again.
What is esophageal achalasia (Achalasia) ?
Esophageal achalasia (Achalasia) is a condition in which the lower esophageal sphincter muscle fails to relax, causing food to remain in the esophagus and preventing it from passing into the stomach normally. The cause is an abnormality of the nerves that control esophageal contractions. This disease cannot be cured completely, but symptoms and quality of life can be controlled.
Symptoms of esophageal achalasia (Achalasia)
- Difficulty swallowing (Dysphagia)
- Chest tightness/pain while swallowing
- Food regurgitation (Regurgitation)
- Choking or coughing at night
- Weight loss
- Malnutrition
Symptoms often progressively worsen if left untreated
Severity of esophageal achalasia (Achalasia)
Symptoms of esophageal achalasia (Achalasia) range from mild to severe. Some people have occasional symptoms, while others have continuous symptoms, significantly affecting daily life. It should be diagnosed and treated as soon as possible.
Diagnostic tests for esophageal achalasia (Achalasia)
Doctors will use several tests together, with the main diagnosis based on the Chicago Classification (v4.0) , including:
- Barium Swallow to assess swallowing and obstruction
- Upper gastrointestinal endoscopy (EGD) to evaluate for obstruction or cancer
- High – Resolution Manometry (HRM) the standard test for diagnosis
- Manometry with Impedance to assess motility and bolus passage
Treatment approaches for esophageal achalasia (Achalasia)
There are several treatments for esophageal achalasia (Achalasia) depending on disease severity as follows:
- Medication for mild symptoms
- Botulinum Toxin Injection – temporarily reduces spasms
- Balloon Dilation (Pneumatic Dilation) – dilates the sphincter
- Surgery (Heller Myotomy)
- POEM endoscopic treatment for esophageal achalasia (Achalasia) without surgery ; according to ACG / ASGE guidelines, POEM is recommended as one of the main treatment methods
POEM What is endoscopic treatment for esophageal achalasia?
POEM (Peroral Endoscopic Myotomy) is a treatment for abnormal esophageal achalasia (Achalasia) using an endoscope passed through the mouth, without open abdominal surgery. The doctor uses an endoscope to cut the lower esophageal sphincter muscle to help food and liquids pass into the stomach more easily. It is a Minimally Invasive treatment with a small wound, less pain, and faster recovery.
Steps of endoscopic treatment for esophageal achalasia (POEM)
Endoscopic treatment for esophageal achalasia (POEM) leaves no external wound and is performed under general anesthesia. The steps are as follows:
- Insert an endoscope into the esophagus
- Create a Submucosal Tunnel
- Cut the esophageal sphincter muscle (Myotomy)
- Close the wound with a Clip
Advantages of POEM endoscopic treatment for esophageal achalasia
- No surgery required
- No external wound
- Less pain
- Faster recovery
- Short hospital stay (1 – 3 days)
- High success rate (>90%)
*Effective in treating all types of esophageal achalasia (Achalasia) including Type III (Spastic Type)
Risks and complications of endoscopic treatment for esophageal achalasia (POEM)
- Bleeding
- Air leak in the chest / abdomen (Pneumoperitoneum)
- Infection (rare)
- Acid reflux (GERD)
*Low complication rate when performed by an experienced specialist
Care after endoscopic treatment for esophageal achalasia (POEM)
- No food for the first 1 – 2 days
- Start with a soft diet
- Take acid-reducing medication
- Follow-up evaluation
*If you have a fever severe chest pain or worsening difficulty swallowing you should see a doctor immediately
Hospital specialized in endoscopic treatment for esophageal achalasia (POEM)
Digestive Disease and Liver Center, Bangkok Hospital is ready to provide diagnostic evaluation and care for esophageal achalasia (Achalasia) with endoscopic treatment for esophageal achalasia (POEM), performed by specialist physicians skilled in advanced endoscopy, nurses, and an experienced multidisciplinary team in managing complex cases, together with modern equipment and technology, to enable faster recovery and a return to good quality of life every day.
Physician specialized in endoscopic treatment for esophageal achalasia (POEM)
Dr. Aroon Siripun Gastroenterologist, Digestive Disease and Liver Center, Bangkok Hospital
You can click here to make an appointment yourself
