Acta Endoscopica

, Volume 43, Issue 3, pp 82–88 | Cite as

Traitement endoscopique de l’achalasie : dilatation pneumatique, chirurgie ou myotomie pérorale endoscopique ?

Revue de Congrès / Congress Review

Résumé

L’achalasie primaire est un trouble moteur oesophagien défini par l’absence de contractions propagées (apéristaltisme) au niveau du corps de l’oesophage et par un défaut de relaxation du sphincter inférieur de l’oesophage. Grâce à l’avènement de la manométrie haute résolution avec l’étude de la topographie de la pression oesophagienne, trois soustypes selon la classification de Chicago se distinguent, ce qui a un intérêt direct sur le choix du traitement à utiliser: l’achalasie de type I répond aussi bien à la dilatation (81 %) qu’à la chirurgie (85 %); l’achalasie de type II, qui est en fait la forme la plus fréquente, répond mieux à la dilatation (100 %); quant à l’achalasie de type III dite « spastique », qui la est la forme la moins fréquente, elle répond mieux à la myotomie laparoscopique de Heller-Dor (86 %). Plus récemment est apparue le myotomie par voie endoscopique qui reste à l’étude en France et qui, au vu des résultats préliminaires, pourrait devenir le traitement de référence et notamment dans le type III qui est la forme la plus résistante.

Mots clés

Achalasie Dilatation pneumatique oesophagienne Injection de toxine botulique Myotomie de Heller-Dor Myotomie endoscopique œsophagienne 

Endoscopic management of achalasia: pneumatic dilatation, surgery or peroral endoscopic myotomy?

Abstract

Achalasia is an esophageal motility disorder defined by the absence of propagated contractions (aperistalsis) in the body of the esophagus and failure of relaxation of the lower esophageal sphincter. Thanks to high resolution manometry and study of the esophageal pressure topography, three subtypes, according to the classification of Chicago, have a direct interest in the choice of treatment to use: type I of achalasia presents the same result with pneumatic dilatation (81%) and surgery (85%); type II of achalasia presents the best result with pneumatic dilatation (100%); type III of achalasia called “spastic”, which is the more resistant, have the best result with Heller-Dor myotomy (86%). More recently appeared the peroral endoscopic myotomy, which remains to study in France, but with the preliminary results, this technic could become the treatment of choice for achalasia, particularly in the type III which is the most resistant.

Keywords

Achalasia Pneumatic dilatation Botulinum toxin injection Heller-Dor myotomy Peroral endoscopic myotomy 

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Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  1. 1.Hôpital privé Jean MermozLyonFrance

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