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Therapie der Achalasie

Alles POEM – oder doch Dilatation und Kardiomyotomie?

Treatment of achalasia

POEM or balloon dilation and Heller myotomy?

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Der Gastroenterologe Aims and scope

Zusammenfassung

Die Achalasiebehandlung besteht aus drei verschiedenen Ansätzen: chirurgische, endoskopische und medikamentöse Therapie. Die endoskopische Ballondilatation (EBD) mit der Option der Nachdilatation bei Symptomen und die laparoskopische Heller-Myotomie (LHM) erzielen sehr gute Ergebnisse und haben innerhalb von 2 Jahren eine ähnliche Erfolgsrate. Langzeitergebnisse jedoch zeigen einen Vorteil für die Myotomie. Die perorale endoskopische Myotomie (POEM) könnte das Beste beider Welten in sich vereinen. Das Zugangstrauma ist minimal, potenziell verbunden mit den Langzeitergebnissen der Myotomie. Erste Ergebnisse zeigen gute Erfolgsraten, ähnlich denen, die mit EBD und LHM erreicht werden können. Die Eingriffe lassen sich mit kommerziell verfügbaren endoskopischen Instrumenten durchführen und zeigen in den Pilotstudien eine geringe Komplikationsrate.

Abstract

The treatment of achalasia consists of three basic concepts: surgical myotomy, endoscopic and medical treatment. Endoscopic balloon dilation (EBD) with the option of redilation in cases of recurrence and laparoscopic Heller myotomy (LHM) have shown good long-term efficacy. At 2 years after initial treatment EBD and LHM have similar remission rates but the long-term results show an advantage for surgical myotomy. Peroral endoscopic myotomy (POEM) has the potential to combine the best of both worlds. The access trauma is minimal and potentially it could achieve the long-term results of surgical myotomy. Preliminary results demonstrate good success rates similar to those which can be achieved with EBD and LHM. The intervention can be performed with commercially available endoscopic instruments and complication rates in reported pilot studies are low.

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Authors and Affiliations

  1. Klinik für Visceral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland

    M. Schoenberg

  2. Klinik und Poliklinik für interdisziplinäre Endoskopie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    T. Rösch & D. von Renteln

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  1. M. Schoenberg
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  2. T. Rösch
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  3. D. von Renteln
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Correspondence to M. Schoenberg.

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Schoenberg, M., Rösch, T. & von Renteln, D. Therapie der Achalasie. Gastroenterologe 8, 106–111 (2013). https://doi.org/10.1007/s11377-012-0733-3

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