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J Pediatr Gastroenterol Nutr 2020 Jun;70(6):e119-e123

Division of Gastroenterology, Hepatology and Nutrition, Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA.

Objectives: Fundoplication is a commonly performed pediatric surgery but the surgery can result in nonspecific symptoms that merit further evaluation. The goal of this study was to determine the utility of Functional Luminal Imaging Probe (FLIP) compared with high-resolution manometry with impedance (HRIM) in the evaluation of fundoplication symptoms.

Methods: We reviewed the FLIP and HRIM tracings of symptomatic fundoplication patients. Read More

ACG Case Rep J 2020 Feb 2;7(2):e00318. Epub 2020 Mar 2.

Department of Gastroenterology, Wake Forest University Baptist Medical Center, Winston Salem, NC.

Pseudoachalasia, clinically indistinct from achalasia in symptoms and high-resolution manometry findings, differs by a secondary etiology with more than half of the occurrences arising from malignancy. Rarely pseudoachalasia presents after surgeries of the esophagus and gastroesophageal junction. This case offers an additional example of pseudoachalasia after Nissen fundoplication; however, it is unique to the literature by documenting complete manometric progression from normal to pseudoachalasia in a single patient. Read More

Gut 2020 May 21. Epub 2020 May 21.

Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

Objective: After treatment, achalasia patients often develop reflux symptoms. Aim of this case-control study was to investigate mechanisms underlying reflux symptoms in treated achalasia patients by analysing oesophageal function, acidification patterns and symptom perception.

Design: Forty treated achalasia patients (mean age 52. Read More

Clin Endosc 2020 May 22. Epub 2020 May 22.

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Background/aims: Peroral endoscopic myotomy (POEM) has recently come to the forefront in the management of achalasia. We aimed to analyze the efficacy and safety of the use of electrocautery enhanced scissors (EES) for POEM.

Methods: This retrospective cohort study prospectively collected the data of all adult patients (aged ≥18 years) with normal foregut anatomy who underwent POEM using EES. Read More

Gastroenterology 2020 May 8. Epub 2020 May 8.

Department of Medicine, Division of Gastroenterology, and Department of Radiology, University of California, San Diego, CA, USA.

Background & Aims: Smooth muscles of the lower esophageal sphincter (LES) and skeletal muscle of the crural diaphragm (esophagus hiatus) provide the sphincter mechanisms at the esophagogastric junction (EGJ). We investigated differences in the 3-dimensional (3D) pressure profile of the LES and hiatal contraction between normal subjects and patients with achalasia esophagus.

Methods: We performed a prospective study of 10 healthy subjects (controls; 7 male; mean age, 60±15 years; mean body mass index, 25 ± 2) and 12 patients with a diagnosis of achalasia (7 male; mean age, 63 ±13 years; mean body mass index, 26 ± 1), enrolled at a gastroenterology clinic. Read More

Curr Opin Gastroenterol 2020 May 13. Epub 2020 May 13.

Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA.

Purpose Of Review: Chronic opioid use is common and can cause opioid-induced esophageal dysfunction (OIED). We will discuss the pathophysiology, diagnosis, and management of OIED.

Recent Findings: OIED is diagnosed based on symptoms, opioid use, and manometric evidence of distal esophageal spasm, esophagogastric junction outflow obstruction, achalasia type III, or jackhammer esophagus. Read More

Asian J Surg 2020 May 15. Epub 2020 May 15.

Department of General Surgery, Sarawak General Hospital, Kuching, Sarawak, Malaysia.

Background: To evaluate the clinical outcomes and satisfaction of patients following laparoscopic Heller myotomy for achalasia cardia in four tertiary centers.

Methods: Fifty-five patients with achalasia cardia who underwent laparoscopic Heller myotomy between 2010 and 2019 were enrolled. The adverse events and clinical outcomes were analyzed. Read More

Gastrointest Endosc 2020 May 14. Epub 2020 May 14.

Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Background And Aims: The newest addition in the management of achalasia and esophagogastric junction outflow obstruction (EGJOO) is a 30 mm hydrostatic balloon dilator that uses impedance planimetry technology. It allows for the measurement of the diameter and cross-sectional area to determine effective dilation. We aimed to (1) determine the clinical success (defined as a decrease in Eckardt score to ≤3) in the treatment of esophageal motility disorders; (2) report the safety (rate/severity of adverse events (AEs)). Read More

Dig Endosc 2020 May 16. Epub 2020 May 16.

Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.

Workshops on "Innovative Therapeutic Endoscopy" for upper gastrointestinal tract diseases were held four times as the Japan Gastroenterological Endoscopic Society (JGES) Core Sessions at the 93rd to 96th Biannual Meetings of the JGES. A total of 48 research presentations (including 2 invited lectures) were reported , and various discussions were held on these topics. When the research presentations were categorized according to the therapeutic procedure, endoscopic submucosal dissection (ESD) was the most frequent with 28 presentations (58. Read More

Curr Opin Gastroenterol 2020 May 7. Epub 2020 May 7.

Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.

Purpose Of Review: The EsoFLIP integrates impedance planimetry technology into a dilator balloon capable of dilating from diameters between 10 and 30 mm via controlled volumetric distension while providing real-time visualization and objective measurement during the dilation procedure, potentially negating the need for fluoroscopy. This review aims to describe the use and application of EsoFLIP and the potential advantages this novel technology may afford.

Recent Findings: Small pilot and retrospective studies demonstrate EsoFLIP feasibility and safety, but larger studies are needed to understand its impact on clinical outcomes. Read More

Esophagus 2020 May 11. Epub 2020 May 11.

Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.

Background: Peroral endoscopic myotomy (POEM) is an appealing treatment for older patients, as it is minimally invasive but highly efficacious similar to surgical myotomy. However, there is a lack of systematic studies analyzing POEM outcomes in young (< 65 years) versus geriatric patients (≥ 65 years). Hence, we aimed to compare the safety and efficacy of POEM in young versus geriatric patients. Read More

J Laparoendosc Adv Surg Tech A 2020 May 11. Epub 2020 May 11.

Department of Surgery, Center for Esophageal and Gastric Surgery, University of Washington School of Medicine, Seattle, Washington, USA.

Achalasia manifests as failure of relaxation of the lower esophageal sphincter resulting in dysphagia. Although there are several medical and endoscopic treatment options, laparoscopic Heller myotomy has excellent short- and long-term outcomes. This article describes in detail our surgical approach to this operation. Read More

Neurogastroenterol Motil 2020 May 11:e13864. Epub 2020 May 11.

Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.

Background: Achalasia is a chronic esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter, determined by an elevated integrated relaxation pressure (IRP > 15 mm Hg) and absent peristalsis. Goal of treatment is facilitation of flow across the EGJ but minimizing postinterventional reflux. A new advanced hydraulic dilation technology, the esophageal functional luminal imaging probe (EsoFLIP), allows dynamic monitoring of hollow organ dimensions while performing hydraulic dilation. Read More

Indian J Gastroenterol 2020 May 9. Epub 2020 May 9.

Department of Gastroenterology, Arihant Hospital and Research Centre, 283-A Gumasta Nagar, Indore, 452 009, India.

Background: A proportion of patients with gastroesophageal reflux disease (GERD) do not respond to proton pump inhibitor (PPI) therapy.

Aim Of The Study: To determine the findings on high-resolution esophageal manometry (HREM) and 24-h pH recording in patients with typical GERD symptoms, refractory to PPI treatment.

Methods: Retrospective analysis of prospectively maintained database of patients referred for HREM and 24-h pH recording was done. Read More

J Thorac Cardiovasc Surg 2020 May 6. Epub 2020 May 6.

Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio.

Aliment Pharmacol Ther 2020 Jun 7;51(11):1130-1138. Epub 2020 May 7.

Department of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

Background: Medications can affect gastrointestinal tract motility. However, their effects on oesophageal motility in particular are often not as widely known or may be underestimated.

Aim: To review the effect of existing medication use on high-resolution oesophageal manometry (HRM) in a 'real-world' setting. Read More

Endoscopy 2020 May 6. Epub 2020 May 6.

Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.

ESGE recommends the use of a graded pneumatic dilation protocol in achalasia, starting with a 30-mm dilation and followed by a 35-mm dilation at a planned interval of 2 - 4 weeks, with a subsequent 40-mm dilation when there is insufficient relief, over both a single balloon dilation procedure or the use of a larger balloon from the outset.Strong recommendation, high quality of evidence, level of agreement 100 %.ESGE recommends being cautious in treating spastic motility disorders other than achalasia with peroral endoscopic myotomy (POEM). Read More

Neurogastroenterol Motil 2020 May 5:e13867. Epub 2020 May 5.

Department of Experimental Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.

Objective: To determine the differences between clinical, manometric, and neuroimmunological profile of esophagogastric junction outflow obstruction (EGJOO) and achalasia patients.

Methods: Seven EGJOO and 27 achalasia patients were enrolled in a blind cross-sectional study. Peripheral blood (PB) of 10 healthy donors and 10 lower esophageal sphincter (LES) muscle biopsies from organ transplant donors were included as controls. Read More

J Vis Exp 2020 Apr 17(158). Epub 2020 Apr 17.

Department of Medicine, Medical Oncology Division, Indiana University Melvin and Bren Simon Cancer Center.

We describe a novel esophagogastric anastomotic technique ("side-to-side: staple line-on-staple line", STS) for intrathoracic anastomoses designed to create a large diameter anastomosis while simultaneously maintaining conduit blood supply. This technique aims to minimize the incidence of anastomotic leaks and strictures, which is a frequent source of morbidity and occasional mortality after esophagectomy. We analyze the results of this STS technique on 368 patients and compared outcomes to 112 patients who underwent esophagogastric anastomoses using an end-to-end stapler (EEA) over an 8-year time interval at our institution. Read More

Esophagus 2020 May 2. Epub 2020 May 2.

Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan Province, China.

Introduction: Peroral esophageal myotomy (POEM) is a novel endoscopic treatment for achalasia. It has gained popularity worldwide among surgeons and endoscopists, but no studies have compared peroral endoscopic short with long myotomy for achalasia. We aimed to compare the clinical efficacy and safety between peroral endoscopic shorter and longer myotomy. Read More

Endosc Int Open 2020 May 17;8(5):E650-E655. Epub 2020 Apr 17.

Division of gastroenterology and hepatology Johns Hopkins Hospital, Baltimore, United States.

Per-oral endoscopic myotomy (POEM) is associated with a short-term clinical response of 82 % to 100 % in treatment of patients with achalasia. Data are limited on the long-term durability of the clinical response in these patients. The aim of this study was to determine the long-term outcomes of patients undergoing POEM for management of achalasia. Read More

Neurogastroenterol Motil 2020 Apr 29:e13857. Epub 2020 Apr 29.

Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA.

Background: Absent esophageal contractility (AC) is distinguished from type 1 achalasia (ACH1) during high-resolution manometry (HRM) on the basis of normal or elevated deglutitive integrated relaxation pressure (IRP) values. However, IRP measurements are subject to pressure recording error. We hypothesized that distinctive responses to pharmacologic provocation using amyl nitrite (AN) and cholecystokinin (CCK) could reliably distinguish AC patients from those with ACH1. Read More

N Engl J Med 2020 04;382(18):e42

University of Colorado Denver School of Medicine, Aurora, CO

ACG Case Rep J 2020 Mar 23;7(3):e00345. Epub 2020 Mar 23.

Division of Community Gastroenterology-Hepatology, Department of Medicine, Albany Medical College, Albany, NY.

Achalasia is an esophageal motility disorder characterized by a lack of peristalsis and an increased lower esophageal sphincter pressure that does not relax with swallowing. High-resolution manometry (HRM), a valuable diagnostic tool for esophageal disorders, often comes with software for automated study interpretation. Although helpful, there are certain caveats in the diagnostic criteria for achalasia which the software may miss. Read More

J Can Assoc Gastroenterol 2020 Apr 8;3(2):57-58. Epub 2019 Jul 8.

Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.

Cureus 2020 Mar 23;12(3):e7379. Epub 2020 Mar 23.

Otolaryngology, Louisiana State University Health Sciences Center Shreveport, Shreveport, USA.

Achalasia is an uncommon disease that occurs due to inability of lower esophageal sphincter from relaxing, leading to dysphagia to liquids and solids. Clues to this diagnosis include: failed treatment with proton pump inhibitors, and changes on imaging studies including chest X-ray and barium esophagogram. Ultimately it is a diagnosis made on esophageal manometry. Read More

Gastrointest Endosc 2020 May;91(5):1045-1049.e1

Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.

J Laparoendosc Adv Surg Tech A 2020 Apr 21. Epub 2020 Apr 21.

Department of Surgery, San Raffaele Hospital, Milan, Italy.

Epiphrenic diverticulum is a rare esophageal disorder occurring as an outpouching of mucosa and submucosa through the muscular layers, within 10 cm above the cardia. As the majority of epiphrenic diverticula are asymptomatic, the real incidence varies because of a considerable number of cases detected incidentally during radiographic or endoscopic evaluation. Traditionally, the operation was performed through a left thoracotomy approach and the diverticulectomy was completed with esophago-cardial myotomy and a Belsey Mark IV fundoplication. Read More

J Laparoendosc Adv Surg Tech A 2020 Apr 21. Epub 2020 Apr 21.

Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.

Over the past decade, per-oral endoscopic myotomy has been shown to be a durable minimally invasive approach to the treatment of esophageal achalasia. Patients with suspected achalasia should undergo upper endoscopy, timed barium esophagram, and high-resolution manometry to confirm the diagnosis. The procedure includes several key steps including mucosotomy, submucosal tunneling, selective myotomy of the circular muscle layer, and mucosotomy closure. Read More

Proc (Bayl Univ Med Cent) 2020 Apr 6;33(2):233-234. Epub 2020 Feb 6.

Texas A&M College of MedicineDallasTexas.

Zenker's diverticulum (ZD) is a rare disorder of the esophagus that occurs in approximately 0.1% of the population. Recently, new minimally invasive techniques have been used to treat ZD. Read More

Gastroenterology 2020 Apr 17. Epub 2020 Apr 17.

Department of Medicine, Division of Gastroenterology and Hepatology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.

J Laparoendosc Adv Surg Tech A 2020 Apr 20. Epub 2020 Apr 20.

Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.

Achalasia is a primary esophageal motility disorder characterized by lack of esophageal peristalsis and partial or absent relaxation of the lower esophageal sphincter in response to swallowing. Available treatment modalities are not curative but rather intend to relieve patient' symptoms. A laparoscopic Heller myotomy with Dor fundoplication is associated with high clinical success rates and low incidence of postoperative reflux. Read More

ACG Case Rep J 2020 Jan 7;7(1):e00298. Epub 2020 Jan 7.

Department of Gastroenterology, Baylor Scott & White Health Medical Center, Temple, TX.

Achalasia is a rare condition that most often presents with progressive dysphagia to solids and liquids. We report a case of achalasia presenting with acute respiratory failure and hemodynamic instability requiring both ventilator and vasopressor support because of extrinsic compression of the airway and left atrium by a dilated and fluid-filled esophagus. This is the first case reported of achalasia, causing both left atrial compression and airway compression. Read More

Gastroenterol Hepatol Bed Bench 2020 ;13(2):181-183

Department of Gastroenterology, University of Toledo Medical Center, Toledo, Ohio, USA.

Type 1 myotonic dystrophy (MD) is a rare inherited disease which presents with skeletal muscle weakness and myotonia. Involvement of smooth muscles is also common and mainly manifests in the gastrointestinal tract. We report a case of type 1 MD who presented with dysphagia and was found to have unique esophageal manometry findings. Read More

Surg Endosc 2020 Apr 17. Epub 2020 Apr 17.

Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.

Background And Objectives: The most efficient long-term treatment strategy for achalasia has yet to be established. This study compared the long-term results (≥ 10 years) after either pneumatic dilatations or laparoscopic myotomy using treatment failure as the primary outcome. Secondary objectives were; the frequency and degree of dysphagia and effects on health-related quality of life (QoL). Read More

J Clin Gastroenterol 2020 Apr 14. Epub 2020 Apr 14.

Norton Thoracic Institute, St Joseph's Hospital Medical Center.

Goals: The authors aimed to compare preperistaltic distal esophageal pressure in patients with esophagogastric junction outflow obstruction (EGJOO) with and without reported dysphagia.

Background: Manometric EGJOO is characterized by elevated integral relaxation pressure (>15 mm Hg) without achalasia. The nomenclature inherently implies that it should be associated with impaired food bolus transit and should theoretically present clinically as dysphagia. Read More

J Gastrointest Surg 2020 Apr 16. Epub 2020 Apr 16.

Department of Surgery, Division of Gastrointestinal and General Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.

Introduction: Laparoscopic Heller Myotomy is the most effective treatment of achalasia. We examined the durability of symptomatic relief, with and without fundoplication.

Methods: A single institution database between 1995 and 2017 was reviewed. Read More

Arq Gastroenterol 2020 Jan-Mar;57(1):79-86

Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Unidade de Endoscopia, Departamento de Gastroenterologia, São Paulo, SP, Brasil.

Background: Achalasia is a neurodegenerative motility esophageal disorder characterized by failure of lower esophageal sphincter relaxation. The conventional treatment option for achalasia has been laparoscopic Heller myotomy (LHM). However, in 2010, Inoue et al. Read More

Clin Gastroenterol Hepatol 2020 Apr 11. Epub 2020 Apr 11.

Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. Electronic address:

JGH Open 2020 Apr 18;4(2):309-311. Epub 2019 Aug 18.

Divisions of Gastroenterology, Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan.

Achalasia is a rare benign esophageal motility disease caused by the impaired relaxation of the lower esophageal sphincter, which results from nerve damage. Patients with achalasia are known to have a high risk of esophageal cancer. Here, we present the case of a patient with achalasia and esophageal cancer in whom the Lugol-voiding areas (LVAs) could be improved by pneumatic dilation and the extending area of esophagus cancer could become clear. Read More

Surg Innov 2020 Apr 10:1553350620913133. Epub 2020 Apr 10.

The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.

Peroral endoscopic myotomy (POEM) is a new technique to treat achalasia, but the effects on esophageal motor function and structure are still unclear. This study aimed to examine the esophageal function and anatomical changes of patients with achalasia treated with POEM. This was a retrospective study of 43 patients with achalasia treated with POEM between January 2013 and January 2016 at the Second Affiliated Hospital of Xi'an Jiaotong University. Read More

Dig Endosc 2020 Apr 9. Epub 2020 Apr 9.

Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.

Objectives: This study compared the safety and efficacy of peroral endoscopic myotomy for esophageal motility disorders between octogenarians and non-octogenarians.

Methods: This retrospective observational study recruited 321 patients (28 octogenarians and 293 non-octogenarians) who underwent peroral endoscopic myotomy from two institutions. Clinical success (postoperative Eckardt score≤3), technical success (completion of gastric and esophageal myotomy), and perioperative adverse events were compared between octogenarians and non-octogenarians. Read More

Endosc Int Open 2020 Apr 23;8(4):E506-E512. Epub 2020 Mar 23.

Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

Achalasia can be classified as either primary (idiopathic) achalasia or secondary achalasia, which is a consequence of another systemic disease. Peroral endoscopic myotomy (POEM) is an effective and safe treatment for achalasia. We evaluated the efficacy and safety of POEM in patients with Chagasic achalasia compared to idiopathic achalasia. Read More

World J Clin Cases 2020 Mar;8(6):1026-1032

Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA 30303, United States.

Distal esophageal spasm (DES) is a rare major motility disorder in the Chicago classification of esophageal motility disorders (CC). DES is diagnosed by finding of ≥ 20% premature contractions, with normal lower esophageal sphincter (LES) relaxation on high-resolution manometry (HRM) in the latest version of CCv3.0. Read More

Scand J Gastroenterol 2020 Apr 6;55(4):509-514. Epub 2020 Apr 6.

Gastroenterology Clinic - Jessenius Faculty of Medicine, Comenius University in Bratislava (JFM CU), Martin, Slovakia.

Standard treatment for esophageal epiphrenic diverticula associated with achalasia includes surgical diverticulectomy, myotomy and anterior fundoplication. However, several case reports published recently suggest that endoscopic approach using per oral endoscopic myotomy is a safe and effective alternative. This is a retrospective review of a single center case series of patients with achalasia and epiphrenic diverticula. Read More

Esophagus 2020 Apr 4. Epub 2020 Apr 4.

Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan.

Background: Noncardiac chest pain often coexists with dysphagia in patients diagnosed with achalasia. The current standard treatment for achalasia, laparoscopic Heller myotomy with Dor fundoplication, has an insufficient effect on noncardiac chest pain. The aim of this study is to investigate the efficacy of circumferential Heller myotomy on esophageal chest pain in patients with achalasia. Read More

N Engl J Med 2020 04;382(14):1377-1378

University Hospital Hamburg-Eppendorf, Hamburg, Germany

N Engl J Med 2020 04;382(14):1377

Asian Institute of Gastroenterology, Hyderabad, India

N Engl J Med 2020 04;382(14):1376-1377

Queen's University, Kingston, ON, Canada.

N Engl J Med 2020 04;382(14):1376

Northwestern University Feinberg School of Medicine, Chicago, IL