Esophagectomy for end-stage achalasia: s it too aggressive?

Achalasia is a progressively worsening primary motility disorder of the esophagus, characterised by a lack of peristalsis and impaired relaxation of the lower esophageal sphincter. The management of this disease aims to palliate symptoms by improving gastric emptying and reducing the pressure gradient. Nonetheless, approximately 5% of patients will progress to end-stage disease with the development of a massively dilated and tortuous megaesophagus. Esophagectomy for the treatment of end-stage achalasia remains a controversial topic and has been recommended as a last resort by the 2018 International Society for Diseases of the Esophagus guidelines. We describe a patient with end-stage achalasia who had exhausted conventional therapy and was successfully managed with an Ivor Lewis esophagectomy, followed by a review of current practice regarding the management of this difficult problem.