Achalasia Flashcards
Recommend patients who are suspected of having GERD but do not respond to acid-suppressive therapy should be evaluated for achalasia.
strong, low evidence
Recommend using esophageal pressure topography over conventional line tracing for the diagnosis of achalasia.
strong, high evidence
We suggest that POEM or PD result in comparable symptomatic improvement in patients with types I or II achalasia.
conditional, low evidence
We recommend that POEM and LHM result in comparable symptomatic improvement in patients with achalasia.
strong, moderate evidence
We recommend tailored POEM or LHM for type III achalasia as a more efficacious alternative disruptive therapy at the LES compared to PD.
strong, moderate evidence
Recommend that PD is superior to medical therapy in relieving symptoms and physiologic parameters of esophageal emptying.
strong, low evidence
Recommend that PD or LHM are both effective and equivalent short- and long-term procedures for patient w/ achalsia who are cadidates to undergo definitive therapy.
strong, high evidence
Recommend LHM over botulinum toxin injection in patient w/ achalasia fit for surgery.
strong, moderate evidence
Suggest that previous treatment w/ botox does not significantly affect performance and outcomes of myotomy.
conditional, low evidence
Recommend that myotomy w/ fundoplication is superior to myotomy without fundoplication in controlling distal esophageal acid exposure.
strong, moderate evidence
Suggest either Dor or Toupet fundoplication to control esophageal acid exposure in patients w/ achalasia undergoing surgical myotomy.
conditional, moderate evidence
Recommend against stent placement for management of long-term dysphagia in patients w/ achalasia.
strong, low evidence
Recommend against obtaining routine gastrograffin esophagram after dilation. This test should be reserved for patient w/ a clinical suspicion for perforation after dilation.
strong, low evidence
Suggest that ES or HRN alone not be used to define treatment failure in evaluating continued or recurrent symptoms after definitive therapy for achalasia.
strong, very low evidence
Recommend using TBE as the first-line test in evaluating continued or recurrent symptoms after definitive therapy for achalasia.
strong, very low evidence
Suggest that in patient w/ achalasia, POEM compared w/ LHM w/ fundoplication or PD is associated w/ a higher incidence of GERD.
strong, moderate evidence
Recommend that PD is an appropriate and safe treatment option for patients w/ achalasia post-initial surgical myotomy or POEM in need of retreatment.
strong, moderate evidence
Suggest that POEM is a safe option in patients w/ achalasia who have previously undergone PD or LHM.
strong, low evidence
Suggest that Heller myotomy be considered before esophagectomy in patients who have failed PD and POEM if the anatomy is conducive, and there is evidence of incomplete myotomy.
strong, very low evidence
Recommend esophagectomy in surgically-fit patients w/ megaesophagus who have failed other interventions.
strong, low evidence
Suggest against routine endoscopic surveillance for esophageal carcinoma in patients with achalasia.
strong, low evidence
