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de Moura et al. Mini-invasive Surg 2017;1:148-52 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2017.27
www.misjournal.net
Topic: Achalasia Management: the South American viewpoint Open Access

Endoscopic pneumatic dilatation and

peroral endoscopic myotomy in dilated

megaesophagus

Eduardo Turiani Hourneaux de Moura, Eduardo Guimarães Hourneaux de Moura
Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, SP 01246-903, Brazil.

Correspondence to: Dr. Eduardo Turiani Hourneaux de Moura, Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of São Paulo Medical
School, 255, São Paulo, SP 01246-903, Brazil. E-mail: duduthmoura@gmail.com

How to cite this article: de Moura ETH, de Moura EGH. Endoscopic pneumatic dilatation and peroral endoscopic myotomy in dilated megaesophagus.
Mini-invasive Surg 2017;1:148-52.

ABSTRACT
Article history: Achalasia is a primary esophageal disorderth variable causes, with an incidence between 0.03
Received: 20 Jul 2017 to 1/100,000 people, and prevalence of approximately 10/100,000, with no difference between
First Decision: 1 Aug 2017 gender. It is more frequent in South and Central America, where Chagas disease is endemic.
Revised: 11 Sep 2017 There are several methods to treat achalasia including endoscopic and surgical procedures,
Accepted: 28 Sep 2017 however, all of these methods are palliative. This article discusses 2 different endoscopic
Published: 28 Dec 2017 methods to treat advanced megaesophagus in Chagas disease, pneumatic balloon dilatation
(PBD), and peroral endoscopic myotomy (POEM). Although varying between studies, PBD has
Key words: an average symptom relief in 93% of patients in 6 months and 44% in 6 years. Some risk factors
Chagas disease, for failure of PBD are: younger age, male gender, a wider esophagus, poor emptying on post-
megaesophagus, treatment barium esophagogram and Eckardt scale < 3 before the treatment. Despite relatively
sigmoid-shaped esophagus, short-term follow-up of an average of 3 years, POEM has excellent results. The clinical success
pneumatic dilatation, achieved in 98 % with the Eckardt score decreased from 6.9 preoperatively to 0.77. Regarding
peroral endoscopic myotomy, sigmoid-shaped esophagus, only a few papers have been published on POEM. The largest
endoscopic gastrointestinal population was 32 patients with a follow-up of 2 years. There was an efficacy of 96%, with the
surgery procedures Eckardt scale decreasing from 7.8 to 1.4. In conclusion, PBD, is still widely used mainly due to
its availability, especially in patients with a higher surgical risk and in patients who already had
a Heller myotomy who persist or develop dysphagia. POEM has already demonstrated excellent
results, but it requires advanced technical skills and Long-term results and randomized clinical
trials are needed to validate the use of POEM in routine clinical practice.

INTRODUCTION It is more frequent in South and Central America, where
Chagas disease is endemic. In addition to infectious
Achalasia is a primary esophageal disorder of variable etiology, other causes of achalasia are idiopathic,
causes, with an incidence between 0.03 to 1/100,000 autoimmune, or drug-related .
[5]
people, and a prevalence of approximately 10/100,000,
with no difference between gender [1-4] . Chagas disease is an incurable disease where there

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