Role of biodegradable stents in octogenarians with achalasia

Achalasia is a primary motility disorder of the esophagus characterized by the loss of inhibitory neurons in the myenteric plexus. Incidence peaks in the third and seventh decades of life [1] [2] It is an incurable disease and definitive treatment is aimed at disrupting the lower esophageal sphincter (LES). Aggressive treatment routes tend to be more durable but are fraught with potentially morbid adverse events (AEs) that may not be tolerated by those with little health reserve. Pneumatic dilation (PD) and laparoscopic Heller myotomy (LHM) have historically been the mainstay therapeutic interventions in patients with acceptable surgical risks. Per-oral endoscopic myotomy (POEM) has emerged as a non-inferior alternative to LHM with comparable risk profile. It is known that higher American Society of Anesthesiologists (ASA) score is associated with more anesthesia-related serious AEs [3]. Due to fear of procedure-related AEs in the face of increased burden of medical comorbidities, achalasia patients 75 years and older are sometimes left untreated [4]. Medication use, akin to nitrates and calcium channel blockers, is virtually ineffective and is marred by intolerable cardiovascular AEs. Botulinum toxin injection is a viable choice, albeit with limited effectiveness and durability [4].

Publikationsverlauf

Artikel online veröffentlicht:
27. Mai 2021

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