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Экспериментальная и клиническая гастроэнтерология

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Диагностика и лечение ахалазии кардии — обзор зарубежной литературы

https://doi.org/10.31146/1682-8658-ecg-177-5-21-35

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Аннотация

Введение. В связи с появлением новых методов диагностики и лечения ахалазии кардии повысился интерес к этому заболеванию. За рубежом новые методики внедряются на несколько лет раньше, чем в России, чаще проводятся проспективные рандомизированные исследования, по результатам которых создаются клинические рекомендации. Поэтому авторами приводится обширный обзор зарубежной литературы, посвященной диагностике и лечению ахалазии кардии, в котором отражены не только современные тенденции, но и те направления, которым уделяли внимание исследователи прошлых лет.
Результаты. Описаны традиционные и новые методы диагностики (хронометрированная контрастная рентгенография и манометрия высокого разрешения). Приведена классификация типов ахалазии согласно версии 3.0 Чикагской классификации нарушений моторики пищевода. Представлен весь спектр лечения ахалазии кардии — консервативными и оперативными методами с анализом ближайших и отдаленных результатов, в том числе в сравнительном аспекте и при сочетанном применении нескольких методик у одного пациента. Рассмотрена сложная задача выбора метода лечения терминальной стадии ахалазии кардии. По ключевым моментам диагностики и лечения заболевания приведены опубликованные в 2020 г. клинические рекомендации по ахалазии Европейского союза гастроэнтерологии и Европейского общества нейрогастроэнтерологии и моторики.
Заключение. Ахалазия кардии — хроническое заболевание, по поводу лечения которого нет единого мнения. Баллонная пневмодилатация, пероральная эндоскопическая миотомия и лапароскопическая миотомия Геллера с фундопликацией являются безопасными и высокоэффективными методами и могут быть рекомендованы для лечения ахалазии. В настоящее время наблюдается постепенный переход к менее инвазивному первоначальному лечению терминальной стадии ахалазии, но для получения окончательных данных о различных вариантах лечения необходимо проведение крупных многоцентровых и рандомизированных исследований.

Об авторах

Э. А. Годжелло
Федеральное государственное бюджетное научное учреждение «Российский научный центр хирургии имени академика Б. В. Петровского»
Россия
Годжелло Элина Алексеевна, д. м. н., главный научный сотрудник эндоскопического отделения 119991 г. Москва, Абрикосовский пер., д. 2


М. В. Хрусталева
Федеральное государственное бюджетное научное учреждение «Российский научный центр хирургии имени академика Б. В. Петровского»
Россия

Хрусталева Марина Валерьевна, д. м. н., руководитель эндоскопического отделения 

119991 г. Москва, Абрикосовский пер., д. 2 



Д. Г. Шатверян
Федеральное государственное бюджетное научное учреждение «Российский научный центр хирургии имени академика Б. В. Петровского»
Россия

Шатверян Диана Гарниковна, к. м. н., старший научный сотрудник эндоскопического отделения

119991 г. Москва, Абрикосовский пер., д. 2 



Н. А. Булганина
Федеральное государственное бюджетное научное учреждение «Российский научный центр хирургии имени академика Б. В. Петровского»
Россия

Булганина Наталья Анатольевна, к. м. н., научный сотрудник эндоскопического отделения

119991 г. Москва, Абрикосовский пер., д. 2 



Список литературы

1. Vaezi M.F., Richter J. E. Diagnosis and management of achalasia. American College of Gastroenterology Practice Parameter Committee. Am J Gastro-enterol. 1999; 94: 3406–3412. [PubMed].

2. Hirota W.K., Zuckerman M. J., Adler D. G., Davila R. E., Egan J., Leighton J. A., Qureshi W. A., Rajan E., Fanelli R., Wheeler-Harbaugh J. et al. ASGE guideline: the role of endoscopy in the surveillance of premalignant condi-tions of the upper GI tract. Gastrointest Endosc. 2006; 63: 570–580. [PubMed].

3. Stefanidis D., Richardson W., Farrell T. M. et al. SAGES guidelines for the surgical treatment of esophageal achalasia. Surg Endosc. 2012; 26(2): 296–311. [PubMed].

4. Vaezi M.F., Pandolfino J. E., Vela M. F. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol. 2013; 108: 1238–1249; quiz 1250. [PubMed].

5. Oude Nijhuis R. A.B., Zaninotto G., Roman S. et al. European Guideline on Achalasia – UEG and ESNM recommendations. United European Gastro-enterology Journal 2020, Vol.8(1): 13–34.

6. Neyaz Z., Gupta M., Ghoshal U. C. How to perform and interpret timed barium esophagogram. J. Neurogastroenterol. Motil. 2013; 19: 251–6.

7. Patti M.G., Feo C. V., Diener U. et al. Laparoscopic Heller myotomy re-lieves dysphagia in achalasia when the esophagus is dilated. Surg.Endosc. 1999; 13: 843–7.

8. Sweet M.P., Nipomnick I., Gasper W. J. et al. The outcome of laparoscopic Heller myotomy for achalasia is not influenced by the degree of esophageal dilatation. J. Gastrointest. Surg. 2008; 12:159–65.

9. Inoue H., Minami H., Kobayashi Y. et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010; 42:265–71.

10. Pandolfino J.E., Kwiatek M. A., Nealis T., Bulsiewicz W., Post J., Kahrilas P. J. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology 2008; 135:1526–33.

11. Krill J.T., Naik R. D., Vaezi M. F. Clinical management of achalasia: current state of the art Clin Exp Gastroenterol. 2016; 9: 71–82. Published online 2016 Apr 4. doi: 10.2147/CEG.S84019 PMCID: PMC4831602 PMID: 27110134

12. Kahrilas P.J., Bredenoord A. J., Fox M. et al. The Chicago classifica-tion of esophageal motility disorders, v3.0. Neurogastroenterol. Motil. 2015; 27: 160–74.

13. Min M., Peng L. H., Yang Y. S. et al. Characteristics of achalasia sub-types in untreated Chinese patients: a high-resolution manometry study. J. Dig. Dis. 2012; 13: 504–9.

14. Kahrilas P. J., Boeckxstaens G. The spectrum of achalasia: lessons from studies of pathophysiology and high-resolution manometry. Gastro-enterology 2013; 145: 954–65.

15. Rohof W. O., Salvador R., Annese V. et al. Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterology 2013; 144: 718–25. quiz e13–4. doi: 10.1053/j.gastro.2012.12.027. Epub 2012 Dec 28.

16. Bassotti G., Annese V. Review article: pharmacological options in achalasia. Aliment. Pharmacol. Ther. 1999; 13: 1391–6.

17. Bortolotti M., Labo G. Clinical and manometric effects of nifedipine in patients with esophageal achalasia. Gastroenterology 1981; 80:39–44.

18. Nasrallah S. M., Tommaso C. L., Singleton R. T., Backhaus E. A. Pri-mary esophageal motor disorders: clinical response to nifedipine. South Med. J. 1985; 78: 312–15.

19. Traube M., Dubovik S., Lange R. C., McCallum R. W. The role of ni-fedipine therapy in achalasia: results of a randomized, double-blind, place-bo-controlled study. Am. J. Gastroenterol. 1989; 84: 1259–62.

20. Triadafilopoulos G., Aaronson M., Sackel S., Burakoff R. Medical treatment of esophageal achalasia. Double-blind crossover study with oral nifedipine, verapamil, and placebo. Dig. Dis. Sci. 1991; 36:260–7.

21. Annese V., Bassotti G. Non-surgical treatment of esophageal achalas-ia. World J. Gastroenterol. 2006; 12: 5763–6.

22. Yon J., Christensen J. An uncontrolled comparison of treatments for achalasia. Ann. Surg. 1975; 182: 672.

23. Gelfond M., Rozen P., Gilat T. Isosorbide dinitrate and nifedipine treatment of achalasia: a clinical, manometric and radionuclide evaluation. Gastroenterology 1982; 83: 963–9.

24. Maksimak M., Perlmutter D. H., Winter H. S. The use of nifedipine for the treatment of achalasia in children. J. Pediatr. Gastroenterol. Nutr.1986; 5: 883.

25. Coccia G., Bortolotti M., Michetti P., Dodero M. Return of esopha-geal peristalsis after nifedipine therapy in patients with idiopathic esopha-geal achalasia. Am. J. Gastroenterol. 1992; 87: 1705–8.

26. Bortolotti M., Coccia G., Brunelli F. et al. Isosorbide dinitrate or ni-fedipine: which is preferable in the medical therapy of achalasia? Ital. J. Gastroenterol. 1994; 26: 379–82.

27. Wen Z. H., Gardener E., Wang Y. P. Nitrates for achalasia. Cochrane Database Syst. Rev. 2004: No.1, Article ID: CD002299. http://dx.doi.org/10.1002/14651858.CD002299.pub2.

28. Ponce J., Garrigues V., Pertejo V., Sala T., Berenguer J. Individual prediction of response to pneumatic dilation in patients with achalasia. Dig Dis Sci. 1996; 41: 2135–2141. [PubMed].

29. Alonso-Aguirre P., Aba-Garrote C., Estévez-Prieto E., González-Conde B., Vázquez-Iglesias J. L. Treatment of achalasia with the Witzel di-lator: a prospective randomized study of two methods. Endoscopy. 2003; 35: 379–382. [PubMed].

30. Tuset J.A., Luján M., Huguet J. M., Canelles P., Medina E. Endoscop-ic pneumatic balloon dilation in primary achalasia: predictive factors, complications, and long-term follow-up. Dis Esophagus. 2009; 22: 74–79. [PubMed].

31. Farhoomand K., Connor J. T., Richter J. E., Achkar E., Vaezi M. F. Predictors of outcome of pneumatic dilation in achalasia. Clin Gastroenter-ol Hepatol. 2004; 2: 389–394. [PubMed].

32. Campos G. M., Vittinghoff E., Rabl C., Takata M., Gadenstätter M., Lin F., Ciovica R. Endoscopic and surgical treatments for achalasia: a sys-tematic review and meta-analysis. Ann Surg. 2009; 249: 45–57. [PubMed].

33. Moonen A. J., Boeckxstaens G. E. Management of achalas-ia. Gastroenterol Clin North Am. 2013; 42: 45–55. [PubMed].

34. Richter J.E., Boeckxstaens G. E. Management of achalasia: surgery or pneumatic dilation. Gut. 2011; 60: 869–876. [PubMed].

35. Gideon R. M., Castell D. O., Yarze J. Prospective randomized compar-ison of pneumatic dilatation technique in patients with idiopathic achalas-ia. Dig Dis Sci. 1999; 44: 1853–1857. [PubMed].

36. Eckardt V. F., Aignherr C., Bernhard G. Predictors of outcome in pa-tients with achalasia treated by pneumatic dila-tion. Gastroenterology. 1992; 103: 1732–1738. [PubMed].

37. Kadakia S. C., Wong R. K. Graded pneumatic dilation using Rigiflex achalasia dilators in patients with primary esophageal achalasia. Am J Gastroenterol. 1993; 88: 34–38. [PubMed].

38. Hulselmans M., Vanuytsel T., Degreef T., Sifrim D., Coosemans W., Lerut T., Tack J. Long-term outcome of pneumatic dilation in the treatment of achalasia. Clin Gastroenterol Hepatol. 2010; 8: 30–35. [PubMed].

39. Vela M.F., Richter J. E., Khandwala F., Blackstone E. H., Wachs-berger D., Baker M. E., Rice T. W. The long-term efficacy of pneumatic dila-tation and Heller myotomy for the treatment of achalasia. Clin Gastroen-terol Hepatol.2006; 4: 580–587. [PubMed].

40. Rohof W.O., Lei A., Boeckxstaens G. E. Esophageal stasis on a timed barium esophagogram predicts recurrent symptoms in patients with long-standing achalasia. Am J Gastroenterol. 2013; 108: 49–55. [PubMed].

41. O’Connor J. B., Singer M. E., Imperiale T. F., Vaezi M. F., Richter J. E. The cost-effectiveness of treatment strategies for achalasia. Dig Dis Sci. 2002; 47: 1516–1525. [PubMed].

42. Karanicolas P. J., Smith S. E., Inculet R. I., Malthaner R. A., Reynolds R. P., Goeree R., Gafni A. The cost of laparoscopic myotomy versus pneu-matic dilatation for esophageal achalasia. Surg Endosc. 2007; 21: 1198–1206. [PubMed].

43. West R. L., Hirsch D. P., Bartelsman J. F., de Borst J., Ferwerda G., Tytgat G. N., Boeckxstaens G. E. Long term results of pneumatic dilation in achalasia followed for more than 5 years. Am J Gastroenterol. 2002; 97: 1346– 1351. [PubMed].

44. Eckardt V. F., Gockel I., Bernhard G. Pneumatic dilation for achalas-ia: late results of a prospective follow up investigation. Gut. 2004; 53: 629–633. [PMC free article] [PubMed].

45. Katsinelos P., Kountouras J., Paroutoglou G., Beltsis A., Zavos C., Papaziogas B., Mimidis K. Long-term results of pneumatic dilation for achalasia: a 15 years’ experience. World J Gastroenterol. 2005; 11: 5701–5705. [PMC free article] [PubMed].

46. Vaezi M. F., Baker M. E., Achkar E., Richter J. E. Timed barium oe-sophagram: better predictor of long term success after pneumatic dilation in achalasia than symptom assessment. Gut. 2002; 50: 765–770. [PMC free article] [PubMed].

47. Ghoshal U.C., Kumar S., Saraswat V. A., Aggarwal R., Misra A., Choudhuri G. Long-term follow-up after pneumatic dilation for achalasia cardia: factors associated with treatment failure and recurrence. Am J Gas-troenterol. 2004; 99: 2304–2310. [PubMed].

48. Gockel I., Junginger T., Bernhard G., Eckardt V. F. Heller myotomy for failed pneumatic dilation in achalasia: how effective is it. Ann Surg. 2004; 239: 371–377. [PMC free article] [PubMed].

49. Dağli U., Kuran S., Savaş N., Ozin Y., Alkim C., Atalay F., Sahin B. Factors predicting outcome of balloon dilatation in achalasia. Dig Dis Sci. 2009; 54: 1237–1242. [PubMed].

50. Eckardt A.J., Eckardt V. F. Current clinical approach to achalas-ia. World J Gastroenterol. 2009; 15: 3969–3975. [PMC free arti-cle] [PubMed].

51. Tanaka Y., Iwakiri K., Kawami N. et al. Predictors of a better out-come of pneumatic dilatation in patients with primary achalasia. J. Gastro-enterol. 2010; 45: 153–8.

52. Alderliesten J., Conchillo J. M., Leeuwenburgh I., Steyerberg E. W., Kuipers E. J. Predictors for outcome of failure of balloon dilatation in pa-tients with achalasia. Gut. 2011; 60: 10–16. [PMC free article] [PubMed].

53. Ghoshal U. C., Rangan M. A review of factors predicting outcome of pneumatic dilation in patients with achalasia cardia. J. Neurogastroenterol. Motil. 2011; 17: 9–13.

54. Ghoshal U. C., Rangan M., Misra A. Pneumatic dilation for achalasia cardia: reduction in lower esophageal sphincter pressure in assessing re-sponse and factors associated with recurrence during long-term follow up. Dig. Endosc. 2012; 24: 7–15.

55. Metman E. H., Lagasse J. P., d’Alteroche L., Picon L., Scotto B., Barbieux J. P. Risk factors for immediate complications after progressive pneumatic dilation for achalasia. Am J Gastroenterol. 1999; 94: 1179–1185. [PubMed].

56. Vanuytsel T., Lerut T., Coosemans W., Vanbeckevoort D., Blondeau K., Boeckxstaens G., Tack J. Conservative management of esophageal per-forations during pneumatic dilation for idiopathic esophageal achalas-ia. Clin Gastroenterol Hepatol. 2012; 10: 142–149. [PubMed].

57. Richter J. E. Update on the management of achalasia: balloons, sur-gery and drugs. Expert Rev Gastroenterol Hepatol. 2008; 2: 435–445. [PubMed].

58. Zerbib F., Thétiot V., Richy F., Benajah D. A., Message L., Lamouli-atte H. Repeated pneumatic dilations as longterm maintenance therapy for esophageal achalasia. Am J Gastroenterol. 2006; 101: 692–697. [PubMed].

59. Pasricha P. J., Ravich W. J., Hendrix T. R., Sostre S., Jones B., Kalloo A. N. Treatment of achalasia with intrasphincteric injection of botulinum toxin. A pilot trial. Ann. Intern. Med. 1994; 121: 590–1.

60. Pasricha P. J., Ravich W. J., Hendrix T. R., Sostre S., Jones B., Kalloo A. N. Intrasphincteric botulinum toxin for the treatment of achalasia. N. Engl. J. Med. 1995; 332: 774–8.

61. Fishman V. M., Parkman H. P., Schiano T. D. et al. Symptomatic im-provement in achalasia after botulinum toxin injection of the lower esoph-ageal sphincter. Am. J. Gastroenterol. 1996; 91: 1724–30.

62. Pasricha P. J., Rai R., Ravich W. J., Hendrix T. R., Kalloo A. N. Botu-linum toxin for achalasia: long-term outcome and predictors of response. Gastroenterology 1996; 110: 1410.

63. Cuilliere C., Ducrotte P., Zerbib F. et al. Achalasia: outcome of pa-tients treated with intrasphincteric injection of botulinum toxin. Gut. 1997; 41: 87–92.

64. Kolbasnik J., Waterfall W. E., Fachnie B., Chen Y., Tougas G. Long-term efficacy of Botulinum toxin in classical achalasia: a prospective study. Am. J. Gastroenterol. 1999; 94: 3434–9.

65. Prakash C., Freedland K. E., Chan M. F., Clouse R. E. Botulinum tox-in injections for achalasia symptoms can approximate the short term effi-cacy of a single pneumatic dilation: a survival analysis approach. Am. J. Gastroenterol. 1999; 94: 328–33.

66. Vaezi M. F., Richter J. E., Wilcox C. M., Schroeder P. L., Birgisson S., Slaughter R. L., Koehler R. E., Baker M. E. Botulinum toxin versus pneu-matic dilatation in the treatment of achalasia: a randomised tri-al. Gut. 1999; 44: 231–239. [PMC free article] [PubMed].

67. Annese V., Bassotti G., Coccia G., Dinelli M., D’Onofrio V., Gatto G., Leandro G., Repici A., Testoni P. A., Andriulli A. A multicentre ran-domised study of intrasphincteric botulinum toxin in patients with oesoph-ageal achalasia. GISMAD Achalasia Study Group. Gut. 2000; 46: 597–600. [PMC free article] [PubMed].

68. Horgan S., Hudda K., Eubanks T., McAllister J., Pellegrini C. A. Does botulinum toxin injection make esophagomyotomy a more difficult opera-tion. Surg Endosc. 1999; 13: 576–579. [PubMed].

69. Patti M. G., Feo C. V., Arcerito M., De Pinto M., Tamburini A., Diener U., Gantert W., Way L. W. Effects of previous treatment on results of laparoscopic Heller myotomy for achalasia. Dig Dis Sci. 1999; 44: 2270–2276. [PubMed].

70. D’Onofrio V., Annese V., Miletto P. et al. Long-term follow-up of achalasic patients treated with botulinum toxin. Dis. Esophagus 2000; 13: 96–101; discussion 2–3.

71. Smith C. D., Stival A., Howell D. L., Swafford V. Endoscopic therapy for achalasia before Heller myotomy results in worse outcomes than heller myotomy alone. Ann Surg. 2006; 243: 579–584; discussion 584–586. [PMC free article] [PubMed].

72. Marjoux S., Brochard C., Roman S. et al. Botulinum toxin injection for hypercontractile or spastic esophageal motility disorders: may highres-olution manometry help to select cases? Dis. Esophagus 2015; 28:735–41.

73. van Hoeij F. B., Tack J. F., Pandolfino J. E., Sternbach J. M., Roman S., Smout A. J. P. M., Bredenoord A. J. Complications of botulinum toxin injections for treatment of esophageal motility disorders. Diseases of the Esophagus, Volume 30, Issue 3, March 2017, Pages 1–5, https://doi.org/10.1111/dote.12491

74. Kumar A. R., Schnoll-Sussman F. H., Katz P. O. Botulinum toxin and pneumatic dilation in the treatment of achalasia. Tec Gastrointest En-dosc. 2014; 16: 10–19.

75. Zaninotto G., Annese V., Costantini M. et al. Randomized controlled trial of botulinum toxin versus laparoscopic Heller myotomy for esophage-al achalasia. Ann. Surg. 2004; 239: 364–70.

76. Storr M., Born P., Frimberger E. et al. Treatment of achalasia: the shortterm response to botulinum toxin injection seems to be independent of any kind of pretreatment. BMC Gastroenterol. 2002; 2: 19.

77. Vaezi M. F., Richter J. E. Current therapies for achalasia: comparison and efficacy. J Clin Gastroenterol.1998; 27(1): 21–35. [PubMed].

78. Ali A., Pellegrini C. A. Laparoscopic myotomy: technique and effica-cy in treating achalasia. Gastrointest Endosc Clin N Am. 2001; 11(2): 347–358. [PubMed].

79. Melvin W. S., Needleman B. J., Krause K. R., Wolf R. K., Michler R. E., Ellison E. C. Computer-assisted robotic heller myotomy: initial case re-port. J Laparoendosc Adv Surg Tech A. 2001; 11(4): 251–253. [PubMed].

80. Khashab M. A., Kumbhari V., Tieu A. H. et al. Peroral endoscopic myotomy achieves similar clinical response but incurs lesser charges com-pared to robotic heller myotomy. Saudi J. Gastroenterol. 2017; 23: 91–6.

81. Ali A. B., Khan N. A., Nguyen D. T. et al. Robotic and per-oral endo-scopic myotomy have fewer technical complications compared to laparo-scopic Heller myotomy. Surg Endosc 2019 Sep 3. doi: 10.1007/s00464–019–07093–2. [Epub ahead of print]. https://doi.org/10.1007/s00464-019-07093-2.

82. Richards W. O., Torquati A., Holzman M. D. et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospec-tive randomized double-blind clinical trial. Ann Surg. 2004; 240(3): 405–412. discussion 412–415. [PMC free article] [PubMed].

83. Li Q. L., Zhou P. H. Perspective on peroral endoscopic myotomy for achalasia: Zhongshan experience. Gut Liver 2015; 9: 152–8. [Crossref] [PubMed].

84. Bechara R., Onimaru M., Ikeda H. et al. Per-oral endoscopic myoto-my, 1000 cases later: pearls, pitfalls, and practical considerations. Gastro-intest Endosc 2016; 84: 330–8.

85. Allaix M. E., Patti M. G. New trends and concepts in diagnosis and treatment of achalasia. Cir Esp.2013; 91: 352–357. [PubMed].

86. Inoue H., Santi E. G., Onimaru M., Kudo S. E. Submucosal endosco-py: from ESD to POEM and beyond. Gastrointest Endosc Clin N Am. 2014; 24: 257–264. [PubMed].

87. Kohn G. P. Peroral endoscopic myotomy for achalasia – a review. Ann Laparosc Endosc Surg 2019; 4: 89. doi: 10.21037/ ales.2019.08.11.

88. Inoue H., Sato H., Ikeda H. et al. Per-oral endoscopic myotomy: a se-ries of 500 patients. J. Am. Coll. Surg. 2015; 221: 256–64.

89. Ramchandani M., Nageshwar Reddy D., Darisetty S. et al. Peroral endoscopic myotomy for achalasia cardia: treatment analysis and follow up of over 200 consecutive patients at a single center. Dig.Endosc. 2016; 28: 19–26.

90. Nabi Z., Ramchandani M., Chavan R. et al. Per-oral endoscopic myo-tomy for achalasia cardia: outcomes in over 400 consecutive patients. En-dosc. Int. Open. 2017; 5: E331-E339.

91. Costamagna G., Marchese M., Familiari P. et al. Peroral endoscopic myotomy (POEM) for oesophageal achalasia: preliminary results in hu-mans. Dig Liver Dis 2012; 44: 827–32.

92. Familiari P., Gigante G., Marchese M. et al. Peroral Endoscopic Myo-tomy for Esophageal Achalasia: Outcomes of the First 100 Patients With Short-term Follow-up. Ann Surg 2016; 263: 82–7.

93. von Renteln D., Inoue H., Minami H., Werner Y. B., Pace A., Kersten J. F., Much C. C., Schachschal G., Mann O., Keller J. et al. Peroral endo-scopic myotomy for the treatment of achalasia: a prospective single center study. Am J Gastroenterol. 2012; 107: 411–417.

94. Sanaka M.R., Hayat U., Thota P. N. et al. Efficacy of peroral endo-scopic myotomy vs other achalasia treatments in improving esophageal function. World J Gastroenterol 2016; 22: 4918–25.

95. Familiari P., Gigante G., Marchese M., Boskoski I., Bove V., Tringali A., Perri V., Onder G., Costamagna G. EndoFLIP system for the in-traoperative evaluation of peroral endoscopic myotomy. United European Gastroenterol J. 2014; 2: 77–83.

96. Chen X., Li Q. P., Ji G. Z. et al. Two-year follow-up for 45 patients with achalasia who underwent peroral endoscopic myotomy. Eur J Cardio-thorac Surg 2015; 47: 890–6.

97. Vigneswaran Y., Tanaka R., Gitelis M. et al. Quality of life assess-ment after peroral endoscopic myotomy. Surg Endosc 2015; 29: 1198–202.

98. Khashab M.A., Messallam A. A., Onimaru M. et al. International multicenter experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video). Gastrointest. Endosc. 2015; 81: 1170–7.

99. Khan M. A., Kumbhari V., Ngamruengphong S. et al. Is poem the an-swer for management of spastic esophageal disorders? A systematic review and meta-analysis. Dig. Dis. Sci. 2017; 62: 35–44.

100. Patel K., Abbassi-Ghadi N., Markar S., Kumar S., Jethwa P., Zani-notto G. Peroral endoscopic myotomy for the treatment of esophageal achalasia: systematic review and pooled analysis. Dis. Esophagus. 2016 Oct; 29(7): 807–819. doi: 10.1111/dote.12387. Epub 2015 Jul 14.

101. Sharata A. M., Dunst C. M., Pescarus R. et al. Peroral endoscopic myotomy (POEM) for esophageal primary motility disorders: analysis of 100 consecutive patients. J Gastrointest Surg 2015; 19: 161–70.

102. ASGE Technology Committee, Pannala R., Abu Dayyeh B. K. et al. Per-oral endoscopic myotomy (with video). Gastrointest Endosc 2016; 83: 1051–60.

103. Hungness E. S., Sternbach J. M., Teitelbaum E. N., Kahrilas P. J., Pan-dolfino J.E., Soper N. J. Per-oral endoscopic myotomy (POEM) after the learning curve: durable long-term results with a low complication rate. Ann. Surg. 2016; 264: 508–17.

104. Werner Y.B., Costamagna G., Swanstrom L. L. et al. Clinical re-sponse to peroral endoscopic myotomy in patients with idiopathic achalas-ia at a minimum follow-up of 2 years. Gut. 2016; 65: 899–906.

105. Ngamruengphong S., Inoue H., Chiu P. W. et al. Long-term outcomes of per-oral endoscopic myotomy in patients with achalasia with a mini-mum follow-up of 2 years: an international multicenter study. Gastrointest. Endosc. 2017 May; 85(5): 927–933.e2. doi: 10.1016/j.gie.2016.09.017. Epub 2016 Sep 20.

106. Hu J. W., Li Q. L., Zhou P. H. et al. Peroral endoscopic myotomy for advanced achalasia with sigmoid-shaped esophagus: long-term outcomes from a prospective, single-center study. Surg. Endosc. 2015; 29: 2841–50.

107. Lv L., Liu J., Tan Y., Liu D. Peroral endoscopic full-thickness myo-tomy for the treatment of sigmoid-type achalasia: outcomes with a mini-mum follow-up of 12 months. Eur. J. Gastroenterol. Hepatol.2016; 28: 30–6.

108. Vela M.F., Richter J. E., Wachsberger D., Connor J., Rice T. W. Com-plexities of managing achalasia at a tertiary referral center: use of pneumat-ic dilatation, Heller myotomy, and botulinum toxin injection. Am. J. Gas-troenterol. 2004; 99: 1029–36.

109. Duranceau A., Liberman M., Martin J., Ferraro P. End-stage achalas-ia. Dis. Esophagus 2012; 25: 319–30.

110. Sawas T., Ravi K., Geno D. M. et al. The course of achalasia one to four decades after initial treatment. Aliment. Pharmacol. Ther. 2017; 45: 553–60.

111. Watson T. J. Esophagectomy for end-stage achalasia. World J. Surg. 2015; 39: 1634–41.

112. Felix V. N. Esophagectomy for end-stage achalasia. Ann. N. Y. Acad. Sci. 2016; 1381: 92–7.

113. Devaney E. J., Lannettoni M. D., Orringer M. B., Marshall B. Esoph-agectomy for achalasia: patient selection and clinical experience. Ann. Thorac. Surg. 2001; 72: 854–8.

114. Vaezi M. F., Baker M. E., Achkar E., Richter J. E. Timed barium oe-sophagram: better predictor of long term success after pneumatic dilation in achalasia than symptom assessment. Gut. 2002; 50: 765–70.

115. Ghoshal U. C., Gupta M., Verma A. et al. High-resolution manometry is comparable to timed barium esophagogram for assessing response to pneumatic dilation in patients with achalasia. Indian J. Gastroenterol. 2015; 34: 144–51.

116. Allescher H. D., Storr M., Seige M., Gonzales-Donoso R., Ott R., Born P., Frimberger E., Weigert N., Stier A., Kurjak M. et al. Treatment of achalasia: botulinum toxin injection vs. pneumatic balloon dilation. A pro-spective study with long-term follow-Up. Endoscopy. 2001; 33: 1007–1017. [PubMed].

117. Ghoshal U.C., Chaudhuri S., Pal B. B., Dhar K., Ray G., Banerjee P. K. Randomized controlled trial of intrasphincteric botulinum toxin A in-jection versus balloon dilatation in treatment of achalasia cardia. Dis Esophagus. 2001; 14: 227–231. [PubMed].

118. Wang L., Li Y. M., Li L. Meta-analysis of randomized and controlled treatment trials for achalasia. Dig Dis Sci. 2009; 54: 2303–2311. [PubMed].

119. Leyden J.E., Moss A. C., MacMathuna P. Endoscopic pneumatic dila-tion versus botulinum toxin injection in the management of primary acha-lasia. The Cochrane database of systematic reviews 2014: Cd005046. 2014/12/ 09. DOI:10.1002/14651858.CD005046.pub3.

120. Ramzan Z., Nassri A. B. The role of Botulinum toxin injection in the management of achalasia. Curr Opin Gastroenterol. 2013; 29: 468–473. [PubMed].

121. Mikaeli J., Bishehsari F., Montazeri G., Mahdavinia M., Yaghoobi M., Darvish-Moghadam S., Farrokhi F., Shirani S., Estakhri A., Malekza-deh R. Injection of botulinum toxin before pneumatic dilatation in achalasia treatment: a randomized-controlled trial. Aliment Pharmacol Ther. 2006; 24: 983–989. [PubMed].

122. Zhu Q., Liu J., Yang C. Clinical study on combined therapy of botu-linum toxin injection and small balloon dilation in patients with esophageal achalasia. Dig Surg. 2009; 26: 493–498. [PubMed].

123. Zaninotto G., Annese V., Costantini M., Del Genio A., Costantino M., Epifani M., Gatto G., D’onofrio V., Benini L., Contini S. et al. Ran-domized controlled trial of botulinum toxin versus laparoscopic heller my-otomy for esophageal achalasia. Ann Surg. 2004; 239: 364–370. [PMC free article] [PubMed].

124. Bravi I., Nicita M. T., Duca P., Grigolon A., Cantù P., Caparello C., Penagini R. A pneumatic dilation strategy in achalasia: prospective out-come and effects on oesophageal motor function in the long term. Aliment Pharmacol Ther. 2010; 31: 658–665. [PubMed].

125. Boeckxstaens G. E., Annese V., des Varannes S. B., Chaussade S., Costantini M., Cuttitta A., Elizalde J. I., Fumagalli U., Gaudric M., Rohof W. O. et al. Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med. 2011; 364: 1807–1816. [PubMed].

126. Cheng J. W., Li Y., Xing W. O., Lv H. W., Wang H. R. 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 Feb; 96(7): e5525. doi: 10.1097/MD.0000000000005525.

127. Sediqi E., Tsoposidis A., Wallenius V. et al. Laparoscopic Heller myotomy or pneumatic dilatation in achalasia: results of a prospective, randomized study with at least a decade of follow-up. Surg Endosc 2020 Apr 17. doi: 10.1007/s00464-020-07541-4. [Epub ahead of print].

128. Weber C. E., Davis C. S., Kramer H. J., Gibbs J. T., Robles L., Fisichel-la P. M. Medium and long-term outcomes after pneumatic dilation or lapa-roscopic Heller myotomy for achalasia: a meta-analysis. Surg Laparosc Endosc Percutan Tech. 2012; 22: 289–296. [PubMed].

129. Pratap N., Kalapala R., Darisetty S. et al. Achalasia cardia subtyping by high-resolution manometry predicts the therapeutic outcome of pneu-matic balloon dilatation. J. Neurogastroenterol. Motil. 2011; 17: 48–53.

130. Yamashita H., Ashida K., Fukuchi T. et al. Predictive factors associ-ated with the success of pneumatic dilatation in Japanese patients with primary achalasia: a study using high-resolution manometry. Digestion 2013; 87: 23–8.

131. Huh J.Y., Park M. I., Park S. J., Moon W., Kim H. H. Variant achalas-ia, the hole of the original classification. Turk. J. Gastroenterol. 2015; 26: 95–8.

132. Kuribayashi S., Iwakiri K., Kawada A. et al. Variant parameter val-uesas defined by the Chicago criteria-produced by ManoScan and a new system with Unisensor catheter. Neurogastroenterol. Motil. 2015; 27: 188–94.

133. Moonen A., Annese V., Belmans A. et al. Long-term results of the European achalasia trial: a multicentre randomised controlled trial compar-ing pneumatic dilation versus laparoscopic Heller myotomy. Gut. 2016; 65: 732–9.

134. Zaninotto G., Costantini M., Portale G. et al. Etiology, diagnosis, and treatment of failures after laparoscopic Heller myotomy for achalasia. Ann. Surg. 2002; 235: 186–92.

135. Popoff A. M., Myers J. A., Zelhart M., Maroulis B., Mesleh M., Milli-kan K., Luu M. B. Long-term symptom relief and patient satisfaction after Heller myotomy and Toupet fundoplication for achalasia. Am J Surg. 2012; 203: 339–342; discussion 342. [PubMed].

136. Chuah S. K., Chiu C. H., Tai W. C., Lee J. H., Lu H. I., Changchien C. S., Tseng P. H., Wu K. L. Current status in the treatment options for esophageal achalasia. World J Gastroenterol. 2013; 19: 5421–5429. [PMC free article] [PubMed].

137. Kumbhari V., Behary J., Szczesniak M., Zhang T., Cook I. J. Efficacy and safety of pneumatic dilatation for achalasia in the treatment of post-myotomy symptom relapse. Am. J. Gastroenterol. 2013; 108: 1076–81.

138. Wood T. W., Ross S. B., Ryan C. E. et al. Reoperative Heller myoto-my: more pain, less gain. Am. Surg. 2015; 81: 637–45.

139. Hungness E. S., Teitelbaum E. N., Santos B. F. et al. Comparison of perioperative outcomes between peroral esophageal myotomy (POEM) and laparoscopic Heller myotomy. J. Gastrointest. Surg. 2013; 17: 228–35.

140. Teitelbaum E. N., Boris L., Arafat F. O. et al. Comparison of esoph-agogastric junction distensibility changes during POEM and Heller myoto-my using intraoperative FLIP. Surg. Endosc. 2013; 27: 4547–55.

141. Ujiki M. B., Yetasook A. K., Zapf M., Linn J. G., Carbray J. M., Denham W. Peroral endoscopic myotomy: a short-term comparison with the standard laparoscopic approach. Surgery 2013; 154: 893–7; discussion 7–900.

142. Bhayani N. H., Kurian A. A., Dunst C. M., Sharata A. M., Rieder E., Swanstrom L. L. A comparative study on comprehensive, objective out-comes of laparoscopic Heller myotomy with per-oral endoscopic myotomy (POEM) for achalasia. Ann. Surg. 2014; 259: 1098–103.

143. Chan S. M., Wu J. C., Teoh A. Y. et al. Comparison of early outcomes and quality of life after laparoscopic Heller’s cardiomyotomy to peroral endoscopic myotomy for treatment of achalasia. Dig. Endosc. 2016; 28: 27–32.

144. Schneider A. M., Louie B. E., Warren H. F., Farivar A. S., Schembre D. B., Aye R. W. A matched comparison of peroral endoscopic myotomy to laparoscopic Heller myotomy in the treatment of achalasia. J. Gastrointest. Surg. 2016; 20: 1789–96.

145. de Pascale S., Repici A., Puccetti F., Carlani E., Rosati R., Fumagalli U. Peroral endoscopic myotomy versus surgical myotomy for primary achalasia: single-center, retrospective analysis of 74 patients. Dis. Esopha-gus. 2017; 30: 1–7.

146. Ramirez M., Zubieta C., Ciotola F. et al. Peroral endoscopic myoto-my vs. laparoscopic Heller myotomy, does gastric extension length matter? Surg. Endosc. 2018 Jan; 32(1): 282–288. doi: 10.1007/s00464-017-5675-x. Epub 2017 Jun 28.

147. Docimo S. Jr., Mathew A., Shope A. J., Winder J. S., Haluck R. S., Pauli E. M. Reduced postoperative pain scores and narcotic use favor per-oral endoscopic myotomy over laparoscopic Heller myotomy. Surg.Endosc. 2017; 31: 795–800.

148. Miller H. J., Neupane R., Fayezizadeh M., Majumder A., Marks J. M. POEM is a cost-effective procedure: cost-utility analysis of endoscopic and surgical treatment options in the management of achalasia. Surg. Endosc. 2017 Apr; 31(4): 1636–1642. doi: 10.1007/s00464-016-5151-z. Epub 2016 Aug 17.

149. Kumbhari V., Tieu A. H., Onimaru M. et al. Peroral endoscopic myo-tomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients: a multicenter comparative study. Endosc. Int. Open. 2015; 3: E195-E201.

150. Onimaru M., Inoue H., Ikeda H. et al. Peroral endoscopic myotomy is a viable option for failed surgical esophagocardiomyotomy instead of redo surgical Heller myotomy: a single center prospective study. J. Am. Coll. Surg. 2013; 217: 598–605.

151. Sharata A., Kurian A. A., Dunst C. M., Bhayani N. H., Reavis K. M., Swanstrom L. L. Peroral endoscopic myotomy (POEM) is safe and effective in the setting of prior endoscopic intervention. J. Gastrointest. Surg. 2013; 17: 1188–92.

152. Zhou P. H., Li Q. L., Yao L. Q. et al. Peroral endoscopic remyotomy for failed Heller myotomy: a prospective single-center study. Endoscopy 2013; 45: 161–6.

153. Ling T., Guo H., Zou X. Effect of peroral endoscopic myotomy in achalasia patients with failure of prior pneumatic dilation: a prospective case-control study. J. Gastroenterol. Hepatol. 2014; 29: 1609–13.

154. Vigneswaran Y., Yetasook A. K., Zhao J. C., Denham W., Linn J. G., Ujiki M. B. Peroral endoscopic myotomy (POEM): feasible as reoperation following Heller myotomy. J. Gastrointest. Surg. 2014; 18: 1071–6.

155. Orenstein S. B., Raigani S., Wu Y. V. et al. Peroral endoscopic myo-tomy (POEM) leads to similar results in patients with and without prior endoscopic or surgical therapy. Surg. Endosc. 2015; 29: 1064–70.

156. Fumagalli U., Rosati R., De Pascale S. et al. Repeated surgical or en-doscopic myotomy for recurrent dysphagia in patients after previous myo-tomy for achalasia. J. Gastrointest. Surg. 2016; 20: 494–9.

157. Jones E. L., Meara M. P., Pittman M. R., Hazey J. W., Perry K. A. Prior treatment does not influence the performance or early outcome of peroral endoscopic myotomy for achalasia. Surg. Endosc. 2016; 30: 1282–6.

158. Kristensen H. O., Kirkegard J., Kjaer D. W., Mortensen F. V., Kunda R., Bjerregaard N. C. Long-term outcome of peroral endoscopic myotomy for esophageal achalasia in patients with previous Heller myotomy. Surg. Endosc. 2017; 31: 2596–601.

159. Louie B. E., Schneider A. M., Schembre D. B., Aye R. W. Impact of prior interventions on outcomes during per oral endoscopic myotomy. Surg. Endosc. 2017; 31: 1841–8.

160. Tang X., Gong W., Deng Z. et al. Feasibility and safety of peroral en-doscopic myotomy for achalasia after failed endoscopic interventions. Dis. Esophagus. 2017; 30: 1–6.

161. Ngamruengphong S, Inoue H, Ujiki M B et al. Efficacy and safety of peroral endoscopic myotomy for treatment of achalasia after failed Heller myotomy. Clin. Gastroenterol. Hepatol. 2017 Oct; 15(10): 1531–1537.e3. doi: 10.1016/j.cgh.2017.01.031. Epub 2017 Feb 9.

162. Tyberg A., Sharaiha R. Z., Familiari P. et al. Per oral endoscopic my-otomy (POEM) as a salvation technique post Heller: an international expe-rience. Dig. Endosc. 2018 Jan; 30(1): 52–56. doi: 10.1111/den.12918. Epub 2017 Aug 8.

163. Schlottmann F., Luckett D. J., Fine J., Shaheen N. J., Patti M. G. Lapa-roscopic Heller myotomy versus peroral endoscopic myotomy (POEM) for achalasia: a systematic review and meta-analysis. Ann. Surg. May 2017; 267(3): 1–10. DOI: 10.1097/SLA.0000000000002311.

164. Sanaka M.R., Thota P. N., Parikh M. P., Hayat U., Gupta N. M., Gab-bard S., Lopez R., Murthy S., Raja S. Peroral endoscopic myotomy leads to higher rates of abnormal esophageal acid exposure than laparoscopic Heller myotomy in achalasia. Surg Endosc. 2019 Jul; 33(7): 2284–2292. doi: 10.1007/s00464-018-6522-4. Epub 2018 Oct 19.

165. Barbieri L.A., Hassan C., Rosati R., Romario U. F., Correale L., Re-pici A. Systematic review and meta-analysis: efficacy and safety of POEM for achalasia. United European Gastroenterol. J. 2015; 3:325–34.

166. Kumagai K., Tsai J. A., Thorell A., Lundell L., Hakanson B. Peroral endoscopic myotomy for achalasia. Are results comparable to laparoscopic Heller myotomy? Scand. J. Gastroenterol. 2015; 50: 505–12.

167. Talukdar R., Inoue H., Nageshwar Reddy D. Efficacy of peroral en-doscopic myotomy (POEM) in the treatment of achalasia: a systematic re-view and meta-analysis. Surg. Endosc. 2015; 29: 3030–46.

168. Wei M., Yang T., Yang X., Wang Z., Zhou Z. Peroral esophageal myotomy versus laparoscopic Heller’s myotomy for achalasia: a meta-analysis. J. Laparoendosc. Adv. Surg. Tech. A 2015; 25: 123–9.

169. Akintoye E., Kumar N., Obaitan I., Alayo Q. A., Thompson C. C. Peroral endoscopic myotomy: a meta-analysis. Endoscopy 2016; 48: 1059–68.

170. Marano L., Pallabazzer G., Solito B. et al. Surgery or peroral esoph-ageal myotomy for achalasia: a systematic review and metaanalysis. Medi-cine 2016; 95: e3001.

171. Zhang Y., Wang H., Chen X. et al. Peroral endoscopic myotomy ver-sus laparoscopic Heller myotomy for achalasia: a meta-analysis of nonran-domized comparative studies. Medicine 2016; 95: e2736.

172. Awaiz A., Yunus R. M., Khan S., Memon B., Memon M. A. Systemat-ic review and meta-analysis of perioperative outcomes of peroral endo-scopic myotomy (POEM) and laparoscopic heller myotomy (LHM) for achalasia. Surg. Laparosc. Endosc. Percutan. Tech. 2017; 27: 123–31.

173. Crespin O.M., Liu L. W., Parmar A. et al. Safety and efficacy of PO-EM for treatment of achalasia: a systematic review of the literature. Surg. Endosc. 2017 May; 31(5): 2187– 2201. doi: 10.1007/s00464-016-5217-y. Epub 2016 Sep 15.


Для цитирования:


Годжелло Э.А., Хрусталева М.В., Шатверян Д.Г., Булганина Н.А. Диагностика и лечение ахалазии кардии — обзор зарубежной литературы. Экспериментальная и клиническая гастроэнтерология. 2020;174(5):21-35. https://doi.org/10.31146/1682-8658-ecg-177-5-21-35

For citation:


Godzhello E.A., Khrustaleva M.V., Shatveryan D.G., Bulganina N.A. Diagnosis and treatment of achalasia — a review of foreign literature. Experimental and Clinical Gastroenterology. 2020;174(5):21-35. (In Russ.) https://doi.org/10.31146/1682-8658-ecg-177-5-21-35

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