Comparison of Different Treatment Modalities and Treatment Algorithm for Esophageal Achalasia

Available treatments for esophageal achalasia are not curative, but rather aim to eliminate the outflow resistance caused by the non-relaxing lower esophageal sphincter. Nonsurgical modalities include pharmacological therapy, endoscopic botulinum toxin injection, pneumatic dilatation, and per-oral endoscopic myotomy (POEM). Surgical treatments include laparoscopic Heller myotomy and esophagectomy. The aim of this chapter is to review and compare current available treatment modalities for esophageal achalasia and propose an evidence-based treatment algorithm.