Type III achalasia, previously known as spastic achalasia, has been a rare but challenging diagnosis to treat. While it is included in the same diagnostic and treatment paradigm of types I and II achalasia, conventional therapies such as Botulinum Toxin A injection, pneumatic dilation, and Heller myotomy have yielded poor outcomes. Given the longer segment of spastic esophageal muscle, per oral endoscopic myotomy (POEM) is emerging as the dominant treatment paradigm. As such, it behooves us to treat type III achalasia as the unique entity that it is rather than the “garden variety” achalasia.
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