Endoscopic Procedures for Achalasia

Botulinum toxin—commonly known as Botox^®—relaxes the esophageal muscles, making it easier to swallow. This medication slows the release of neurotransmitters, chemical messengers that signal muscle contraction. Botox^® is often recommended for people with achalasia who are older or cannot have surgery due to other medical conditions. 

Botox^® is administered during a procedure called an upper endoscopy, in which doctors view the esophagus using an endoscope, a flexible tube with a camera at the tip. During the upper endoscopy, the doctor injects Botox^® into the lower esophageal sphincter. The injection of Botox^® only adds about five minutes to the total time of the endoscopy. 

Although Botox^® usually provides several months of relief, you may have to repeat the injections regularly. Also, the effectiveness of therapy may lessen over time in some people.

NYU Langone gastroenterologists may perform a procedure called balloon dilation—in particular, pneumatic dilatation—to widen the lower esophageal sphincter, which can become too tight in people with achalasia. Depending on how the condition affects you, your doctor may recommend this as the best treatment option. 

Balloon dilation is performed during an upper endoscopy and adds about 20 to 30 minutes to the procedure. During the endoscopy, a doctor uses a thin catheter to place a tiny deflated balloon at the lower esophageal sphincter. X-rays are taken during the procedure to ensure proper placement of the balloon. After it is in place, the balloon is inflated to widen the lower esophageal sphincter. 

After a balloon dilation procedure, NYU Langone doctors monitor you for complications, such as bleeding and temporary chest pain. In a small percentage of people, the balloon can tear the muscles in the esophagus, which requires surgery. The vast majority of people return home the same day.