Resumo

PENALOZA RAMIREZ, Arecio  e  SUAREZ CORREA, Juliana. In defense of endoscopic management of achalasia. Rev Col Gastroenterol [online]. 2012, vol.27, n.2, pp.100-103. ISSN 0120-9957.

Achalasia is an esophageal pathology which significantly compromises patient quality of life. Its pathophysiology is not well understood and its etiology has not yet been established. Available treatments are generally palliative. A significant percentage of patients, once they have exhausted all endoscopic and surgical options, should be referred for esophagectomy. Therapeutic endoscopy offers pneumatic balloon dilation guided by endoscopy with excellent results. Laparoscopic Heller myotomy associated with partial fundoplication is the surgical treatment of choice: its results are comparable to those obtained with endoscopic pneumatic balloon dilatation. However, surgical myotomy is a technique that is not without risks, some patients do not accept it and others are not good candidates for the procedure. For some time now the idea that laparoscopic Heller myotomy is superior to endoscopic pneumatic balloon dilation has been popularized, but this is based on questionable studies. The development of therapeutic endoscopy and the growing awareness of the deeper layers of the gastrointestinal tract have made the concept of transmural endoscopic surgery possible to the point that performing a submucosal endoscopic myotomy is now an alternative for management of Achalasia. Therapeutic endoscopy using available methods and techniques is still under study but will remain a first line treatment option for managing these patients.

Palavras-chave : Achalasia; dilatation; surgery; myotomy.

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