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Endoskopie heute 2012; 25(3): 175-179
DOI: 10.1055/s-0032-1325362
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Endoskopische Therapie der Achalasie

Endoscopic Therapy of Achalasia
D. v. Renteln
,
T. Rösch
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Publication History

Publication Date:
12 October 2012 (online)

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Zusammenfassung

Die Achalasie ist eine primäre Motilitätsstö­rung der glatten Muskulatur des tubulären Ösophagus und des unteren Ösophagussphinkters (UÖS), die mit einer Inzidenz von ca. 1/100 000 auftritt. Die Symptome der Achalasie lassen sich effektiv chirurgisch oder endoskopisch behandeln. Als endoskopische Verfahren sind die Botulinumtoxininjektion (BTI), die endoskopische Ballondilatation (EBD) und die perorale endoskopische Myotomie (POEM) verfügbar. Die BTI ist ein fast risikofreier Eingriff, der therapeutische Effekt hält jedoch bei > 50 % der Patienten weniger als 1 Jahr an. Die EBD zeigt mit ca. 70 % etwas bessere Langzeitremissionsraten, ist dafür auch mit einem etwas höheren Komplikationsrisiko assoziiert (z. B. Perforationen). POEM basiert auf den Prinzipien der laparoskopischen Heller-Myotomie, wird jedoch komplett endoskopisch und ohne Bauchschnitte durchgeführt. Bisherige Studienergebnisse zu POEM sind sehr vielversprechend. Es liegen bisher jedoch nur Kurzzeitdaten nach Therapie vor, sodass weitere Studien zeigen müssen, ob POEM gleichwertige Langzeitremissionsraten wie die laparoskopische Heller-Myotomie erreicht.

Abstract

Achalasia ia a rare primary esophageal motility disorder with an incidence of 1:100.000. Available treatment strategies are surgical or endoscopy. Endoscopic treatment strategies are the injection of botulinum toxin (BTI), balloon dilatation (EBD) and more recently Peroral Endoascopic Myotomy (POEM). BTI procedures carry a low procedural risk but are only of limited efficacy. The therapeutic effect wears of in > 50 % within one year. EBD is associated with a little higher risk for procedural complications, especially perforations, and has a sustained efficacy in approximately 70 % of patients. POEM tries to emulate the surgical myotomy using only endoscopy and avoiding skin incisions. Short term results are very promising, but long-term data hast o be awaited to see if therapeutic efficacy is comparable to is laparoscopic Heller myotomy with is about 90 % long-term remission rate.

Schlüsselwörter

Achalasie - Dysphagie - Myotomie - Endoskopische Ballondilatation - Perorale Endoskopische Myotomie

Key words

Achalasia - Dysphagia - Myotomy - Endoscopic Balloon Dilatation - Peroral Endoscopic Myotomy
 

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