Recurrent dysphagia and/or regurgitation occurs in some patients after all treatments for achalasia. Further treatment following botulinum toxin or pneumatic dilatation is generally not difficult, and surgical or transoral endoscopic myotomy are feasible and can generally be undertaken as the next step. Following a failed myotomy, the author's preference is for pneumatic dilatation, with revision myotomy considered if this is not successful. Revision myotomy is technically easier if undertaken via a different body cavity or route to the original myotomy. Symptom improvement can be achieved in 80-90% of individuals after revision treatments. However, a small group continue to experience troublesome symptoms, and if fit should be considered for esophagectomy.
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© 2021 Annals of Esophagus.
- Revision surgery