Z Gastroenterol 2025; 63(05): e313
DOI: 10.1055/s-0045-1809191
Abstracts
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Therapy of Achalasia – A Retrospective Data Analysis at an Esophagus Specialty Outpatient Clinic

Authors

  • A Staszewski

    1   Medizinische Universität Graz, Graz, Austria

  • A Blesl

    2   Medizinische Universität Graz, Klinische Abteilung für Gastroenterologie und Hepatologie, Graz, Austria

  • F Baumann-Durchschein

    2   Medizinische Universität Graz, Klinische Abteilung für Gastroenterologie und Hepatologie, Graz, Austria
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Introduction Peroral endoscopic myotomy (POEM) has emerged as the preferred therapeutic option for treating achalasia. In this study, we aimed to evaluate the treatment outcomes of this method in comparison to pneumatic dilation (PD), Heller myotomy (LHM), and botulinum toxin injections.

Material and Methods This study is a retrospective, single-center data analysis. Included patients had a verified diagnosis of achalasia by endoscopy, high-resolution manometry (HRM) and in recent years functional lumen imaging probe (FLIP). Most patients underwent at least two different types of treatment. Treatment success (remission) was defined using the Eckardt Symptom Score (ESS), with a successful outcome classified as an ESS<3. PD, LHM, POEM sustained remission was defined as maintaining a relapse-free disease control for more than six months. Relapse was defined as worsening of symptoms, accompanied by an ESS of≥3 ([Abb. 1]).

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Abb. 1  Therapy of Achalasia – A Retrospective Data Analysis at an Esophagus Specialty Outpatient Clinic]

Results A total of 125 achalasia patients (72 males [58%], 53 females [42%]; median age 70, IQR 29) were included: Achalasia Type I (n=35), Type II (n=62), Type III (n=21), and 7 unclassified. Among 123 patients treated with botulinum toxin, 104 (85%) had initial success, with 69 (56%) in remission at 12 months. All 21 LHM patients had successful procedures, with 17 (89%) in remission at five years. Of the 15 patients who underwent POEM since 2021, all remained in remission at the end of follow-up (median: 2 years, IQR: 2), though 33% developed GERD. Among 93 PD patients, 84 (90%) had initial success, with 61 (66%) in remission at five years. Relapse was linked to balloon diameters≤30 mm.

Conclusion POEM has the potential to serve as a good long-term treatment for achalasia, but LHM presents a valid therapeutic alternative. Still, PD remains an option in selected patients and results may be improved by a structured three-step dilation protocol using at least a 35mm balloon.



Publication History

Article published online:
13 May 2025

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