Eating depends on a carefully coordinated sequence of movements. Food travels through the oesophagus through rhythmic muscular contractions and eventually passes into the stomach through a muscular valve at its lower end. When this movement becomes abnormal, food may take longer to pass or may remain within the oesophagus, leading to symptoms that can interfere with everyday eating.

Conditions affecting oesophageal movement are not always caused by a physical blockage. In disorders such as achalasia, the muscles responsible for moving food and relaxing at the stomach entrance do not function normally. Endoscopic myotomy is one treatment approach designed to address this muscular problem from inside the digestive tract.

The Oesophagus Relies on Coordinated Muscle Activity

The oesophagus is not simply a hollow tube. Its muscles contract in a coordinated sequence to push swallowed food downwards. At the same time, the lower oesophageal sphincter needs to relax at the appropriate moment. If these actions become poorly coordinated, swallowing can become increasingly difficult. Food may move slowly, and some people may experience regurgitation or discomfort because material remains in the oesophagus for longer than it should.

Achalasia Can Change the Way Food Passes

Achalasia is a disorder in which the lower oesophageal sphincter does not relax normally and the usual muscular movement of the oesophagus is impaired. Symptoms may develop gradually, which means a person may initially adjust eating habits without recognising that an underlying motility disorder is present. Difficulty swallowing both solid foods and liquids can occur. Regurgitation, chest discomfort, coughing at night and weight loss may also be experienced by some patients.

Different Tests Can Show How the Oesophagus Is Working

Symptoms alone cannot establish whether a person has achalasia or another motility disorder. Doctors may use investigations that examine both the structure and function of the oesophagus.

Endoscopy can help rule out physical obstruction or other abnormalities, while oesophageal manometry measures pressure and muscle activity. A contrast swallow study may also provide information about how food or liquid moves through the oesophagus.

Assessment may consider:

• The pattern and duration of swallowing difficulty
• Whether solids, liquids or both cause symptoms
• Oesophageal pressure and muscle activity
• The appearance of the oesophagus on imaging or endoscopy
• Previous treatment for swallowing disorders
• Nutritional status and weight changes

Myotomy Targets the Abnormal Muscle Resistance

An endoscopic myotomy is designed to ease the muscular tightness that makes it difficult for food to move from the oesophagus into the stomach. During the procedure, an endoscope is passed through the mouth and guided into the oesophagus, allowing the specialist to reach the muscle layer without making an external incision.

The specialist creates a small passage beneath the inner lining of the oesophagus to access the underlying muscle. Carefully selected muscle fibres are then divided to reduce the resistance at the lower oesophageal sphincter, after which the entry point is closed using endoscopic techniques. Dr. Kapil Sharma, the endoscopic myotomy expert in Hauz Khas, considers the patient's oesophageal function, diagnostic findings and type of motility disorder when planning the extent of the myotomy. The treatment is therefore adapted to the muscle pattern involved rather than performed in exactly the same way for every patient.

Treatment Choice Depends on the Individual Disorder

Endoscopic myotomy is not automatically appropriate for every person experiencing swallowing difficulty. Different oesophageal disorders can require different treatment strategies, and the cause of the symptoms needs to be established first.

Previous procedures may also influence planning. A patient who has already undergone another treatment for achalasia may have different anatomical or clinical considerations from someone receiving treatment for the first time.

Recovery Still Requires Careful Observation

Although the procedure is performed through the mouth rather than through an external surgical incision, the treated oesophageal tissue still needs time to heal. Patients may initially follow a modified diet while swallowing gradually becomes more comfortable.

Temporary chest discomfort or other digestive symptoms can occur during recovery. The medical team may also monitor for complications and assess how well swallowing improves after treatment.

Reflux Can Occur After Muscle Relaxation

The lower oesophageal sphincter normally acts as a barrier against the movement of stomach contents back into the oesophagus. Reducing its muscular resistance can improve the passage of food, but it can also make reflux more likely in some patients.

This is why follow-up after endoscopic myotomy is important. Symptoms such as heartburn or regurgitation can be assessed and managed when necessary rather than being overlooked simply because the original swallowing problem has improved.

Frequently Asked Questions

Is endoscopic myotomy only used for achalasia?

It is primarily associated with achalasia but may also be considered for selected oesophageal motility disorders. The underlying diagnosis determines whether it is appropriate.

Does endoscopic myotomy involve an external incision?

No. The procedure is performed through the mouth using an endoscope, so there is no large external surgical incision.

Can swallowing improve after myotomy?

The procedure is designed to reduce abnormal muscular resistance and improve the passage of food. The degree of improvement varies between individuals and depends on the underlying condition.

Why is manometry important before treatment?

Manometry provides information about oesophageal pressure and muscle function, helping distinguish different motility disorders and supporting treatment planning.

Conclusion

Difficulty swallowing can sometimes result from abnormal oesophageal muscle function rather than a physical blockage. Endoscopic myotomy addresses this problem by dividing selected muscle fibres through an endoscopic approach, but appropriate patient selection and diagnostic assessment remain essential.

CTA

Dr. Kapil Sharma, the endoscopic myotomy expert in Hauz Khas, provides treatment planning for suitable patients with achalasia and other selected oesophageal motility disorders.

Meta Description

Understand how endoscopic myotomy addresses abnormal oesophageal muscle activity, how achalasia is assessed and what recovery and reflux management may involve.

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