Figure 3.

Proposed therapeutic algorithm for achalasia based on surgical risk. Currently established treatments are in bold. Investigational ones are in italics. Arrows indicate current first-line treatments. Lines binding different treatments indicate management of failures. Dotted lines indicate assumed steps in management, while solid lines the to-date recommended[11]. PD: Pneumatic dilation; LHM: Laparoscopic Heller myotomy; BTI: Botulinum toxin injection; twpcSEMS: Temporal, wide, partially covered, self-expandable metallic stent; POEM: Peroral endoscopic myotomy.