Self-expandable metal stents for achalasia： Thinking out ofthe box!
摘要
Achalasia is a primary motor disorder of the esophagusdiagnosed manometrically in the clinical settingof dysphagia to both solids and liquids. Currentlyestablished treatment options include pneumaticdilation, laparoscopic Heller myotomy, botulinumtoxin injection performed endoscopically, oral agentsthat relax the lower esophageal sphincter andesophagectomy for refractory, end-stage disease.Despite their effectiveness, a significant proportion ofpatients eventually relapses and needs retreatment.In this setting, several new techniques are underinvestigation promising future enrichment of ourtherapeutic armamentarium for achalasic patients.Among them, peroral endoscopic myotomy and selfexpandablemetal stents placed across the gastroesophagealjunction represent the most encouragingmodalities, as initial studies assessing their efficacy andsafety indicate. This review highlights the role of selfexpandablemetal stents in the management of patientswith achalasia. Their possible position in the therapeuticalgorithm of achalasia along with established and noveltechniques is also assessed. Finally, the need for largeprospective randomized trials is underlined in order toelucidate the numerous relevant issues.