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Kaibysheva V.O.
N.I. Pirogov Russian National Research Medical University, Moscow, Russia;
City Clinical Hospital №31, Moscow, Russia
Nikonov E.L.
FGBU "Poliklinika #1" Upravleniia delami Prezidenta RF
Plakhov R.V.
Rossiĭskiĭ natsional'nyĭ issledovatel'skiĭ meditsinskiĭ universitet imeni N.I. Pirogova;
Gorodskaia klinicheskaia bol'nitsa #31, Moskva
Fedorov E.D.
Kafedra gospital'noĭ khirurgii #2 i nauchno-issledovatel'skaia laboratoriia khirurgicheskoĭ gastronterologii i ndoskopii Rossiĭskogo gosudarstvennogo meditsinskogo universiteta im. N.I. Pirogova
Shapoval’yants S.G.
Department of Hospital Surgery №2 with the research laboratory of surgical gastroenterology and endoscopy, N.I. Pirogov Russian National Research Medical University, Moscow
Comparison of the modern treatment methods for esophageal achalasia
Journal: Russian Journal of Evidence-Based Gastroenterology. 2019;8(4): 44‑61
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To cite this article:
Kaibysheva VO, Nikonov EL, Plakhov RV, Fedorov ED, Shapoval’yants SG. Comparison of the modern treatment methods for esophageal achalasia. Russian Journal of Evidence-Based Gastroenterology.
2019;8(4):44‑61. (In Russ.)
https://doi.org/10.17116/dokgastro2019804-05144
Aim. To analyze modern treatment methods for achalasia based on esophageal high-resolution manometry data. High-resolution manometry is the «gold standard» in the diagnosis of achalasia. In Chicago Classification of Esophageal Motility Disorders, achalasia divided into three clinically relevant subclasses based on the pattern of contractility in the esophageal body. Different types of esophageal motility disorders in patients with achalasia are essential to determine the prognosis of disease. The most favorable treatment outcomes are observed in patients with achalasia type II (96%). Treatment effectiveness of the patients with achalasia type I inversely correlates with severity of esophageal dilatation (81%). Traditional approaches (pneumocardial dilatation, Heller myotomy) with correction of the only lower esophageal sphincter in patients with achalasia type III are characterized by moderate efficiency (66%). Development of new methods of minimally invasive endoscopic treatment of achalasia (oral endoscopic myotomy) with myotomy length control significantly improved treatment of spastic achalasia (up to 92%). Conclusion. Esophageal high-resolution manometry in patients with suspected achalasia makes it possible to verify the diagnosis, determine the type of achalasia by the Chicago classification and choose the optimal treatment strategy. Oral endoscopic myotomy, balloon pneumocardial dilatation and Heller myotomy are preferred for achalasia type I and II, oral endoscopic myotomy — for achalasia type III and spastic syndromes (distal esophagospasm, hypercontractive esophagus). Botulinum toxin and drug therapy for achalasia have low efficacy, short-term effect and are indicated only for temporary relief of symptoms in preoperative period.
Authors:
Kaibysheva V.O.
N.I. Pirogov Russian National Research Medical University, Moscow, Russia;
City Clinical Hospital №31, Moscow, Russia
Nikonov E.L.
FGBU "Poliklinika #1" Upravleniia delami Prezidenta RF
Plakhov R.V.
Rossiĭskiĭ natsional'nyĭ issledovatel'skiĭ meditsinskiĭ universitet imeni N.I. Pirogova;
Gorodskaia klinicheskaia bol'nitsa #31, Moskva
Fedorov E.D.
Kafedra gospital'noĭ khirurgii #2 i nauchno-issledovatel'skaia laboratoriia khirurgicheskoĭ gastronterologii i ndoskopii Rossiĭskogo gosudarstvennogo meditsinskogo universiteta im. N.I. Pirogova
Shapoval’yants S.G.
Department of Hospital Surgery №2 with the research laboratory of surgical gastroenterology and endoscopy, N.I. Pirogov Russian National Research Medical University, Moscow
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