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Review
. 2020 Apr 30;26(2):180-203.
doi: 10.5056/jnm20014.

2019 Seoul Consensus on Esophageal Achalasia Guidelines

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Free PMC article
Review

2019 Seoul Consensus on Esophageal Achalasia Guidelines

Hye-Kyung Jung et al. J Neurogastroenterol Motil. .
Free PMC article

Abstract

Esophageal achalasia is a primary motility disorder characterized by insufficient lower esophageal sphincter relaxation and loss of esophageal peristalsis. Achalasia is a chronic disease that causes progressive irreversible loss of esophageal motor function. The recent development of high-resolution manometry has facilitated the diagnosis of achalasia, and determining the achalasia subtypes based on high-resolution manometry can be important when deciding on treatment methods. Peroral endoscopic myotomy is less invasive than surgery with comparable efficacy. The present guidelines (the "2019 Seoul Consensus on Esophageal Achalasia Guidelines") were developed based on evidence-based medicine; the Asian Neurogastroenterology and Motility Association and Korean Society of Neurogastroenterology and Motility served as the operating and development committees, respectively. The development of the guidelines began in June 2018, and a draft consensus based on the Delphi process was achieved in April 2019. The guidelines consist of 18 recommendations: 2 pertaining to the definition and epidemiology of achalasia, 6 pertaining to diagnoses, and 10 pertaining to treatments. The endoscopic treatment section is based on the latest evidence from meta-analyses. Clinicians (including gastroenterologists, upper gastrointestinal tract surgeons, general physicians, nurses, and other hospital workers) and patients could use these guidelines to make an informed decision on the management of achalasia.

Keywords: Esophageal achalasia; Esophageal motility disorders; Guideline; Manometry; Myotomy.

Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1.
Figure 1.
Flowchart of the management of esophageal achalasia.
Figure 2.
Figure 2.
Reported incidence and prevalence rates of achalasia. Data are expressed as rates per 100 000 persons per year (incidence/prevalence).
Figure 3.
Figure 3.
Manometric findings of esophageal achalasia. A. Conventional esophageal manometry findings of achalasia. Achalasia is characterized by incomplete lower esophageal sphincter (LES) relaxation upon deglutition, defined as a residual pressure > 10 mmHg, and aperistalsis in the body of the esophagus. In addition, the resting tone of the LES will often be elevated. B. Subtypes of esophageal achalasia identified by high-resolution manometry: type I, classic achalasia with no evidence of pressurization; type II, panesophageal pressurization; and type III, vigorous achalasia or spastic contractions of the distal esophageal segment.
Figure 4.
Figure 4.
Esophagographic findings of esophageal achalasia. A. Barium swallow typically reveals a “bird-beak” appearance of the esophagogastric junction, with a dilated esophageal body and an air-fluid level in the absence of an intragastric air bubble, or even a sigmoid-like appearance (in advanced cases). B. Timed barium esophagography for measuring esophageal emptying at 1, 2, and 5 minutes. The barium column height is measured from the end of the esophagus.
Figure 5.
Figure 5.
Endoscopic findings of esophageal achalasia. A dilated esophagus showing food stasis, saliva and some resistance at the gastroesophageal junction.
Figure 6.
Figure 6.
Meta-analysis comparing peroral endoscopic myotomy (POEM) and laparoscopic Heller myotomy (LHM). During the 3-year follow-up, POEM is comparable to LHM in terms of the postoperative Eckardt score.
Figure 7.
Figure 7.
Comparison of peroral endoscopic myotomy and laparoscopic Heller myotomy in patients with achalasia. POEM, peroral endoscopic myotomy; SMD, standard mean difference; LHM, laparoscopic Heller myotomy.

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