Achalasia. How high-resolution manometry can help to choose correct strategy

Aim. To analyze safety and efficacy of achalasia treatment options from the viewpoint of high-resolution esophageal manometry data. Methods. Literature search was performed in the database of National Center for Biotechnology Information, USA (NCBI) with the use of Keywords “achalasia” in combination with “high resolution esophageal manometry”, “treatment”, “effectiveness”. Inclusion criteria for study results were: type of study -original study or systematic review/meta-analysis; use of high-resolution esophageal manometry (HREM) to confirm and/or evaluate the effectiveness of treatment of achalasia; verified diagnosis of achalasia; availability of data at least in the form of an abstract; age of participants 18 y. o. or older; English or Russian language of the publication; presence of quantitative characteristics supporting conclusions and sufficient to check accordance with the mentioned criteria. Duplicate publications were excluded. Treatment efficacy was assessed on the basis of resolution of symptoms and/or HREM studies. Assessment of safety was retrieved from the presented data when possible. Results. Literature search with the use of keywords gave 1256 of the publications. The final analysis included 65 works selected according to the inclusion criteria. In most of studies analysis of safety and efficacy was related to treatment of achalasia with the use of balloon pneumodilation (EBD), peroral endoscopic myotomy (POEM) and laparoscopic Heller’s myotomy (LMH). The overall effectiveness of these methods ranged from 70 to 100%. In general, higher overall treatment efficacy was observed in type 2 achalasia (about 90-96%). Lower rates of overall treatment efficacy were related to type 3 achalasia especially when EBD and LMH were used. Low rate of efficacy does not allow to recommend the use of EBD when type 3 achalasia is poresent. Minimally invasive endoscopic treatment methods (POEM), allows to regulate the length of myotomy, and reach higher rates of the treatment efficacy in cases of spastic achalasia. Relatively small number of studies assessed the efficacy of non-surgical options of treatment of achalasia (botox injections, L-type Calcium channels blockers, donators of nitrogen oxide, etc.). These methods demonstrated low efficacy and may be used in those cases when surgical treatment is not possible. Conclusions. The use of high-resolution esophageal manometry allows to differentiate when making a choice of the treatment strategy in patients with achalasia, as well as to monitor the effect of the treatment afterwards. It seems reasonable to make HREM a mandatory diagnostic procedure in patients with suspected achalasia, this may help to choose optimal treatment strategy and increase its efficacy.

ахалазия кардии, манометрия пищевода высокого разрешения, пероральная эндоскопическая миотомия, балонная пневмокардиодилятация, миотомия по Геллеру, эффективность, тактика лечения, achalasia, high-resolution esophageal manometry, peroral endoscopic myotomy, esophageal ballon dilation, laparoscopic myotomy by Heller, efficiency, treatment