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Inicio Cirugía Española (English Edition) The evolution of the treatment of esophageal achalasia. Chronicle of a 35-year j...
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Vol. 102. Issue 6.
Pages 340-346 (June 2024)
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Vol. 102. Issue 6.
Pages 340-346 (June 2024)
Special article
The evolution of the treatment of esophageal achalasia. Chronicle of a 35-year journey
Evolución del tratamiento de la acalasia esofágica. Crónica de un viaje de 35 años
Marco G. Pattia,
Corresponding author
Marco.Patti@gmail.com

Corresponding author.
, Fernando A. Herbellab
a Department of Surgery, University of Virginia, Charlottesville, VA, USA
b Department of Surgery. Escola Paulista de Medicine, Sao Paulo, Brazil
Article information
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Abstract

Over the last few decades, significant improvement has been made in both the evaluation and treatment of esophageal achalasia. The Chicago classification, today in version 4.0, is now the standard for diagnosis of achalasia, providing a classification into 3 subtypes with important therapeutic and prognostic implications. Therapy, which was at first mostly limited to pneumatic dilatation, today includes minimally invasive surgery and peroral endoscopic myotomy, allowing for a more tailored approach to patients and better treatment of recurrent symptoms. This review chronicles my personal experience with achalasia over the last 35 years, describing the progress made in the treatment of patients with achalasia.

Keywords:
Achalasia
Persistent dysphagia
Recurrent dysphagia
Eckardt score
Esophageal manometry
Botulinum toxin
Pneumatic dilatation
Laparoscopic Heller myotomy
POEM
Esophagectomy
Resumen

En las últimas décadas se han logrado mejoras significativas tanto en la evaluación como en el tratamiento de la acalasia esofágica. La Clasificación de Chicago, hoy en la versión 4.0, es ahora el estándar para el diagnóstico de la acalasia, permitiendo una clasificación en 3 subtipos con importantes implicaciones terapéuticas y pronósticas. El tratamiento, que al principio se limitaba principalmente a la dilatación neumática, incluye hoy en día la cirugía mínimamente invasiva y la miotomía endoscópica por vía oral, lo que permite un abordaje más personalizado de los pacientes y un mejor tratamiento de los síntomas recurrentes. Esta revisión narra mi experiencia personal con la acalasia durante los últimos 35 años, describiendo el progreso realizado en el tratamiento de los pacientes con acalasia.

Palabras clave:
Acalasia
Disfagia persistente
Disfagia recurrente
Índice Eckardt
Manometria esofágica
Toxina botulínica
Dilatación neumática
Miotomía laparoscópica de Heller
POEM
Esofagectomia

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