AbstractThe objective of the research was to assess the effectiveness of balloon pneumatic dilation and laparoscopic Heller myotomy in treatment of patients with achalasia cardia. Materials and methods. Twenty-one patients with achalasia cardia were examined and treated using pneumatic balloon dilation and laparoscopic Heller myotomy in the Department of Surgery from January 2016 to April 2018. There were 8 (38.1%) men and 13 (61.9%) women at the age of 28 to 75 years (the average age was (51.47 ± 3.63) years) and disease duration of 1 month to 8 years (the average disease duration was (3.05 ± 0.49) years). Results and discussion. With the help of radiological methods of examination, all the patients were divided into 4 groups according to the esophageal diameter: Group I included 5 (23.8%) patients with the esophagus up to 4-5 cm in diameter; Group II comprised 6 (28.6%) patients with the esophagus up to 4-6 cm in diameter; Group III included 5 (23.8%) patients with the esophagus up to 6-8 cm in diameter; Group IV consisted of 5 (23.8%) patients with the esophagus of more than 8 cm in diameter and an S-shaped configuration. A significant decrease in the diameter of the esophagus according to fluoroscopy (p<0.05) alongside with a decrease in the lower esophageal sphincter pressure according to manometry are indicative in assessing the effectiveness of achalasia cardia treatment after minimally invasive surgery. There were no complications when performing pneumatic balloon dilation and laparoscopic Heller myotomy. Conclusions. In 7 (33.3%) patients, recurrences of achalasia cardia after balloon pneumatic dilation occurred within 2 - 10 months: in 4.7% of patients in Group I and 9.5% of patients in Group II, Group III, and Group IV. In recurrent achalasia cardia, repeated dilation was ineffective. There was performed laparoscopic Heller myotomy with Dor fundoplication, which was effective in 80.0% of cases.
Clark SB, Rice TW, Tubbs RR et al. The nature of the myenteric infiltrate in achalasia: an immunohistochemical analysis. Am J Surg Pathol. 2000;24(8):1153-1158. DOI: https://doi.org/10.1097/00000478-200008000-00014 [PMid:10935657]
Enestvedt BK, Williams JL, Sonnenberg A. Epidemiology and practice patterns of achalasia in a large multi-centre database. Aliment Pharmacol Ther. 2011;33(11):1209-1214. DOI: https://doi.org/10.1111/j.1365-2036.2011.04655.x
Francis DL, Katzka DA. Achalasia update on the disease and its treatment. Gastroenterology. 2010;139(2):369-374. DOI: https://doi.org/10.1053/j.gastro.2010.06.024
Salis GB, Mazzadi SA, García AO, Chiocca JC. Pneumatic dilatation in achalasia of the esophagus: a report from Argentina. Dis Esophagus. 2004;17(2):124-8. DOI: https://doi.org/10.1111/j.1442-2050.2004.00388.x
Ghoshal UC, Daschakraborty SB, Singh R. Pathogenesis of achalasia cardia. World J Gastroenterol. 2012;18(24):3050-3057. DOI: https://doi.org/10.3748/wjg.v18.i24.3050
Katada N, Sakuramoto S, Yamashita K et al. Recent trends in the management of achalasia. Ann Thorac Cardiovasc Surg. 2012;18(5):420-428. DOI: https://doi.org/10.5761/atcs.ra.12.01949 [PMid:23099422]
Amani M, Fazlollahi N, Shirani S et al. Assessment of pneumatic balloon dilation in patients with symptomatic relapse after failed Heller myotomy: a single center experience. Middle East J Dig Dis. 2016;8(1):57-62. DOI: https://doi.org/10.15171/mejdd.2016.08
Chrystoja CC, Darling GE, Diamant NE et al. Achalasia-specific quality of life after pneumatic dilation or laparoscopic Heller myotomy with partial fundoplication: a multicenter, randomized clinical trial. Am J Gastroenterol. 2016;111(11):1536-1545. DOI: https://doi.org/10.1038/ajg.2016.402
Illés A, Farkas N, Hegyi P et al. Is Heller myotomy better than balloon dilation? A meta-analysis. J Gastrointestin Liver Dis. 2017;26(2):121-127. DOI: https://doi.org/10.15403/jgld.2014.1121.262.myo
Esposito D, Maione F, D'Alessandro A et al. Endoscopic treatment of esophageal achalasia. World J Gastrointest Endosc. 2016;8(2):30-39. doi: [10.4253/wjge.v8.i2.30] DOI: https://doi.org/10.4253/wjge.v8.i2.30 [PMid:26839644 PMCid:PMC4724029]
Rohof WO, Salvador R, Annese V et al. Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterology. 2013;144(4):718-725. DOI: https://doi.org/10.1053/j.gastro.2012.12.027
Boeckxstaens GE, Annese V, des Varannes SB et al. Pneumatic dilation versus laparoscopic Heller's myotomy for idiopathic achalasia. N Engl J Med. 2011;364(19):1807-1816. DOI: https://doi.org/10.1056/NEJMoa1010502
Cheng JW, Li Y, Xing WQ et al. Laparoscopic Heller myotomy is not superior to pneumatic dilation in the management of primary achalasia: Conclusions of a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017;96(7):e5525. DOI: https://doi.org/10.1097/MD.0000000000005525
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.