Role of endoscopy in diagnosis and treatment of Achalasia
DOI:
https://doi.org/10.47456/rbps.v26isupl_3.15Keywords:
Achalasia, Upper gastrointestinal endoscopy, Esophageal motor disorder, EndoscopyAbstract
Introduction: Achalasia is a rare disease, whose main symptoms are dysphagia, regurgitation and weight loss, but may be nonspecific in the early stages. The diagnosis is defined by esophageal manometry, however, due to its low availability, endoscopy plays an important role in the identification and especially in the treatment of this disease. Objectives: To describe the role of endoscopy in the diagnosis, given the difficulty in accessing manometry, and also in the treatment of achalasia. The endoscopic findings, procedures currently performed and when to use them were highlighted. Methods: Review of the medical literature of articles selected from PubMed. Results: If achalasia is suspected, endoscopy is the first test to be performed to rule out other diseases such as pseudoachalasia and strictures. Furthermore, endoscopic findings can contribute to suspicion of the disease, anticipating a diagnosis that is often late. Regarding treatment, POEM is currently the therapy of choice, especially in type III achalasia, and achieves symptom control in more than 93% of cases. Heller myotomy surgery presents results close to POEM, and even though it is more invasive, it may be the best option in specialized centers. Although less durable, balloon dilation is effective and is often the first choice due to the best cost-benefit and accessibility. Conclusion: Achalasia is a difficult disease to diagnose and a detailed endoscopic evaluation can help identify it early, especially when manometry is unavailable. Treatment must be individualized and currently the best therapies are POEM, followed by surgery, as both present similar and lasting results. Balloon dilation is also effective, with good results, and can often be the first choice for the best cost-benefit.
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