Achalasia
ICD-10 K22.0 · ICD-11 DA21.0

Achalasia: What to Do When the Patient Is Not a Candidate for Definitive Therapy

Standard definitive treatments for achalasia — pneumatic dilation, laparoscopic Heller myotomy, and per-oral endoscopic myotomy (POEM) — are not appropriate for every patient. When those options are not feasible, a separate management pathway applies.

This protocol addresses achalasia in a patient who is not a candidate for definitive therapy — specifically when pneumatic dilation, laparoscopic Heller myotomy, or POEM cannot be performed. These patients require an alternative, non-definitive intervention guided by a distinct evidence-based approach.

Approach

An endoscopy-based injection procedure targeting the lower esophageal sphincter is used in this setting. The complete procedural details, administration parameters, and follow-up criteria are specified in the full structured regimen.

Treatment goal: Clinical success is defined by an Eckardt score of 3 or below — a composite symptom measure covering dysphagia, regurgitation, chest pain, and weight loss.
Instant Access to Structured Evidence-Based Regimens

References

  1. We recommend against the use of botulinum toxin injection as definitive therapy for achalasia patients. Botulinum toxin injection may be reserved for patients who are not candidates for other definitive therapies. DOI: 10.1016/j.gie.2019.04.231
  2. Endoscopy-based injection of botulinum toxin reduces LES pressure by inhibiting release of acetylcholine from nerve endings.
  3. The Eckardt score is based on the summation of 4 symptoms (dysphagia, regurgitation, chest pain, weight loss) that are graded according to severity, and treatment success is defined as a score ≤3.
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