Thomas P. Colletti, DHSc, MPAS, PA-C
Purpose: The purpose of this article is to review the treatment of achalasia and discuss the increased usage of peroral endoscopic myotomy (POEM) and its recent challenging of laparoscopic Heller myotomy (LHM) to be considered the gold standard of treatment.
Method: A PubMed literature search was performed, utilizing the search terms, "Achalasia," "Laparoscopic Heller myotomy," and "POEM." Fifteen pertinent articles resulted and aided in the development of this clinical review.
Results: Evidence consistently demonstrates the non-inferiority of POEM when compared to LHM. Multiple metanalyses and a recent multicenter randomized controlled trial all demonstrated the non-inferiority of POEM when compared to LHM. However, both metanalyses and the randomized controlled trial also demonstrate a higher incidence of gastroesophageal reflux following intervention at a rate of two to nine times higher in the POEM group when compared to patients who have undergone LHM.
Conclusion: Both LHM and POEM are useful treatment modalities for the management of achalasia. However, given the lack of anti-reflux measures available to patients who undergo POEM, LHM should remain the gold standard for the management of achalasia. While POEM is an innovative technique that provides dysphagia relief, further endoscopic innovation is needed to account for the lack of anti-reflux measures at the time of POEM.
Thomas CJ. Management of Achalasia: Has The Gold Standard Changed?. Lynchburg Journal of Medical Science. 2021; 3(2).
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