Monitoring
After initial treatment with pneumatic dilatation, cardiomyotomy, peroral endoscopic myotomy, or injection of onabotulinumtoxinA or abobotulinumtoxinA (both formerly known as botulinum toxin type A), periodic clinical review is recommended to assess the degree of symptom relief. Follow-up timed barium studies, esophageal 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 esophageal malignancy, a rare complication with a poor prognosis. However, there is no consensus on how often surveillance endoscopy should be performed.[86]
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