Current status in the treatment options for esophageal achalasia  

作　　者：Seng-Kee Chuah Chien-Hua Chiu Wei-Chen Tai Jyong-Hong Lee Hung-I Lu Chi-Sin Changchien Ping-Huei Tseng Keng-Liang Wu 

机构地区：[1]Gastrointestinal Motility Unit,Division of Hepatogastroenterology,Kaohsiung Chang Gung Memorial Hospital,and Chang Gung University College of Medicine [2]Division of General Medicine,Department of Medicine,Kaohsiung Chang Gung Memorial Hospital,and Chang Gung University College of Medicine [3]Digestive Disease Center,Department of Medical Research,Show-Chwan Memorial Hospital [4]Division of Thoracic and Cardiovascular Surgery,Kaohsiung Chang Gung Memorial Hospital [5]Department of Internal Medicine,Graduate Institute of Clinical Medicine,National Taiwan University Hospital and College of Medicine,National Taiwan University

出　　处：《World Journal of Gastroenterology》2013年第33期5421-5429,共9页世界胃肠病学杂志（英文版）

摘　　要：Recent advances in the treatment of achalasia include the use of high-resolution manometry to predict the outcome of patients and the introduction of peroral endoscopic myotomy(POEM).The first multicenter randomized,controlled,2-year follow-up study conducted by the European Achalasia Trial group indicated that laparoscopic Heller myotomy(LHM)was not superior to pneumatic dilations(PD).Publications on the long-term success of laparoscopic surgery continue to emerge.In addition,laparoscopic single-site surgery is applicable to advanced laparoscopic operations such as LHM and anterior fundoplication.The optimal treatment option is an ongoing matter of debate.In this review,we provide an update of the current progress in the treatment of esophageal achalasia.Unless new conclusive data prove otherwise,LHM is considered the most durable treatment for achalasia at the expense of increased reflux-associated complications.However,PD is the first choice for non-surgical treatment and is more costeffective.Repeated PD according to an"on-demand"strategy based on symptom recurrence can achieve long-term remission.Decision making should be based on clinical evidence that identifies a subcategory of patients who would benefit from specific treatment options.POEM has shown promise but its long-term efficacy and safety need to be assessed further.Recent advances in the treatment of achalasia include the use of high-resolution manometry to predict the outcome of patients and the introduction of peroral endoscopic myotomy(POEM).The first multicenter randomized,controlled,2-year follow-up study conducted by the European Achalasia Trial group indicated that laparoscopic Heller myotomy(LHM) was not superior to pneumatic dilations(PD).Publications on the long-term success of laparoscopic surgery continue to emerge.In addition,laparoscopic single-site surgery is applicable to advanced laparoscopic operations such as LHM and anterior fundoplication.The optimal treatment option is an ongoing matter of debate.In this review,we provide an update of the current progress in the treatment of esophageal achalasia.Unless new conclusive data prove otherwise,LHM is considered the most durable treatment for achalasia at the expense of increased reflux-associated complications.However,PD is the first choice for non-surgical treatment and is more costeffective.Repeated PD according to an 'on-demand' strategy based on symptom recurrence can achieve long-term remission.Decision making should be based on clinical evidence that identifies a subcategory of patients who would benefit from specific treatment options.POEM has shown promise but its long-term efficacy and safety need to be assessed further.

关 键 词：Esophageal ACHALASIA ENDOSCOPIC pneumatic DILATIONS BOTULINUM injection Peroral ENDOSCOPIC MYOTOMY Minimally invasive HELLER MYOTOMY 

分 类 号：R655.4[医药卫生—外科学]