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Chapter 4
SUMMARY
Achalasia describes a clinical picture where themotility of the oesophagus is malfunctioning
and the relaxation of the lower oesophageal sphincter (LOS) during swallowing is
inadequate. The reasons of achalasia are not clarified yet. Achalasia results in a stasis of food
and liquids with a wide range of other symptoms. There are various treatment options.
Medication is rarely successful. Balloon dilatation and surgical myotomy of the LOS can
reduce symptoms in 60-90% of patients. For the last few years, myotomy has been made
possible by means of peroral endoscopic myotomy (POEM). POEM is performed under
general anaesthesia at the endoscopy suite. Key points from an anaesthesiologic point of
view are an increased risk of aspiration and procedure specific complications, including
perforation, pneumomediastinum, pneumoperitoneum, and pneumothorax.