Monitoring
After initial treatment with pneumatic dilatation, cardiomyotomy, peroral endoscopic myotomy (POEM), or botulinum toxin injection, periodic clinical review is recommended to assess the degree of symptom relief. Patients who undergo POEM should be monitored for GORD.[41] Follow-up timed barium studies, oesophageal scintigraphy, or manometry enable objective measurements of treatment response. The investigation chosen will depend on local resources and expertise. In patients with long-standing achalasia, clinical vigilance, and possibly regular surveillance endoscopy at 3- to 5-year intervals, is needed for prompt recognition of oesophageal malignancy, a rare complication with a poor prognosis. However, there is no consensus on how often surveillance endoscopy should be performed.[83]
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