Endoscopic treatment of esophageal achalasia

• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: ACHALASIA High resolution manometrysubtypes Eckardt SCORE Per-oral endoscopic MYOTOMY PNEUMATIC DILATATION Botulin TOXIN MYOTOMY
• 年，卷（期）: 2016,（2）
• 页码范围: 30-39
• 页数: 10页
• 分类号: R

摘要

Achalasia is a motility disorder of the esophaguscharacterized by dysphagia, regurgitation of undigestedfood, chest pain, weight loss and respiratory symptoms.The most common form of achalasia is the idiopathic one.Diagnosis largely relies upon endoscopy, barium swallowstudy, and high resolution esophageal manometry（HRM）. Barium swallow and manometry after treatmentare also good predictors of success of treatment as it isthe residue symptomatology. Short term improvementin the symptomatology of achalasia can be achievedwith medical therapy with calcium channel blockers orendoscopic botulin toxin injection. Even though fewpatients can be cured with only one treatment andrepeat procedure might be needed, long term relief fromdysphagia can be obtained in about 90% of cases witheither surgical interventions such as laparoscopic Hellermyotomy or with endoscopic techniques such pneumaticdilatation or, more recently, with per-oral endoscopicmyotomy. Age, sex, and manometric type by HRM arealso predictors of responsiveness to treatment. Olderpatients, females and type Ⅱ achalasia are better aftertreatment compared to younger patients, males andtype Ⅲ achalasia. Self-expandable metallic stents are analternative in patients non responding to conventionaltherapies.