Khirurgiia · 2026
[High-resolution esophageal manometry in endoscopic treatment of achalasia cardia].
Аннотация на английскомСтатьяНазвание и аннотация: Перевод в очереди
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Gabriel S A, Bespechny M V, Dynko V Yu, Krushelnitsky V S, Guchetl A Ya, Ryabchun V V, Semergey A G
Аннотация
OBJECTIVE: To present own experience in treating achalasia cardia using peroral endoscopic myotomy, safety and high efficacy of this method, as well as advantages of peroral endoscopic myotomy (POEM).
MATERIAL AND METHODS: The study enrolled 129 patients between August 2017 and January 2025 who underwent POEM. Surgery was performed using standard technique at a distance of approximately 20-25 cm from incisors. After creating a hydraulic cushion with indigo carmine-stained gelofusine, we made longitudinal incision for 1.5-2.0 cm using electrosurgical stand and electric knife. After entering submucosal layer, we created a tunnel to subcardia level. Myotomy was then performed 7-8 cm before the cardia and 2-3 cm after it. Hemostasis was achieved if necessary, and mucosal defect was closed with endoscopic clips.
RESULTS: According to the Eckardt scale, we obtained excellent results in 66 (51.2%) patients and satisfactory results in 55 (42.7%) patients. Unsatisfactory results were observed in 5 (3.8%) patients, poor results - in 3 (2.3%) patients. Among 8 patients with unsatisfactory and poor results, 6 ones had recurrent achalasia, and 2 ones had stage 4 achalasia. Eight patients had access to high-resolution manometry before and after surgery that allowed for clear picture of improvement after POEM.
CONCLUSION: POEM demonstrates excellent results. Most patients experience significant regression or disappearance of dysphagia. Furthermore, POEM offers significant cosmetic benefits, as it eliminates postoperative skin scarring.
MATERIAL AND METHODS: The study enrolled 129 patients between August 2017 and January 2025 who underwent POEM. Surgery was performed using standard technique at a distance of approximately 20-25 cm from incisors. After creating a hydraulic cushion with indigo carmine-stained gelofusine, we made longitudinal incision for 1.5-2.0 cm using electrosurgical stand and electric knife. After entering submucosal layer, we created a tunnel to subcardia level. Myotomy was then performed 7-8 cm before the cardia and 2-3 cm after it. Hemostasis was achieved if necessary, and mucosal defect was closed with endoscopic clips.
RESULTS: According to the Eckardt scale, we obtained excellent results in 66 (51.2%) patients and satisfactory results in 55 (42.7%) patients. Unsatisfactory results were observed in 5 (3.8%) patients, poor results - in 3 (2.3%) patients. Among 8 patients with unsatisfactory and poor results, 6 ones had recurrent achalasia, and 2 ones had stage 4 achalasia. Eight patients had access to high-resolution manometry before and after surgery that allowed for clear picture of improvement after POEM.
CONCLUSION: POEM demonstrates excellent results. Most patients experience significant regression or disappearance of dysphagia. Furthermore, POEM offers significant cosmetic benefits, as it eliminates postoperative skin scarring.