clinendoКлиническая эндоскопияFilin’s Clinical endoscopy2415-7813"Global Media technology" Ltd10.31146/2415-7813-endo-68-2-13-22clinendo-707Research ArticleПЕРЕДОВАЯ СТАТЬЯLEADING ARTICLEПероральная эндоскопическая миотомия (ПОЭМ) в лечении ахалазии пищевода у детей: анализ эффективности и проблема гастроэзофагеального рефлюксаPeroral Endoscopic Myotomy for Esophageal Achalasia in Children: Efficacy and the problem of postoperative gastroesophageal refluxhttps://orcid.org/0000-0002-6440-2370СмирновА. А.SmirnovA. A.noemail@neicon.ruМикаваА. Г.MikavaA. G.noemail@neicon.ruКарповаР. А.KarpovaR. A.rkarpova3@gmail.comhttps://orcid.org/0000-0003-3821-3805КирильцеваМ. М.KiriltsevaM. M.noemail@neicon.ruhttps://orcid.org/0000-0003-1110-1379ЛюбченкоМ. Е.LyubchenkoM. E.noemail@neicon.ruЖароваН. В.ZharovaN. V.noemail@neicon.ruhttps://orcid.org/0000-0002-7795-8108ВитовщикМ. Г.VitovshchikM. G.noemail@neicon.ruhttps://orcid.org/0000-0002-7428-3520МихайловН. И.MikhailovN. I.noemail@neicon.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Первый Санкт-Петербургский государственный медицинский университет им. академика И.П. Павлова» Министерства здравоохранения Российской Федерации; СПб ГБУЗ Детская городская больница № 2 святой Марии МагдалиныPavlov First St. Petersburg State Medical University; St. Mary Magdalene Children’s City Hospital № 2СПб ГБУЗ Детская городская больница № 2 святой Марии МагдалиныSt. Mary Magdalene Children’s City Hospital № 2Федеральное государственное бюджетное образовательное учреждение высшего образования «Первый Санкт-Петербургский государственный медицинский университет им. академика И.П. Павлова» Министерства здравоохранения Российской ФедерацииPavlov First St. Petersburg State Medical UniversityОГАУЗ Городская Ивано-Матренинская детская клиническая больницаIvano-Matreninskaya Children’s City Hospita2026230420266821322Copyright © Смирнов А.А., Микава А.Г., Карпова Р.А., Кирильцева М.М., Любченко М.Е., Жарова Н.В., Витовщик М.Г., Михайлов Н.И., 20262026Смирнов А.А., Микава А.Г., Карпова Р.А., Кирильцева М.М., Любченко М.Е., Жарова Н.В., Витовщик М.Г., Михайлов Н.И.Smirnov A.A., Mikava A.G., Karpova R.A., Kiriltseva M.M., Lyubchenko M.E., Zharova N.V., Vitovshchik M.G., Mikhailov N.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://clinendo.elpub.ru/jour/article/view/707

Ахалазия пищевода представляет собой нейромышечное заболевание, характеризующееся нарушением релаксации нижнего пищеводного сфинктера (НПС) и отсутствием нормальной перистальтики тела пищевода. У детей заболевание встречается с частотой 0,1-0,18 случаев на 100 000 детей в год. «Золотым стандартом» диагностики признана манометрия пищевода высокого разрешения (МВР), позволяющая не только подтвердить диагноз, но и определить манометрический тип ахалазии согласно Чикагской классификации (версия 4.0), что имеет принципиальное значение для выбора правильной протяженности миотомии. Традиционными методами лечения долгое время считались баллонная дилатация и лапароскопическая миотомия Геллера (ЛМГ). Однако первая сопряжена с высоким риском рецидива и необходимостью повторных вмешательств, а вторая, несмотря на высокую эффективность (до 85%), не лишена риска осложнений и неэффективна при спастическом (III) типе ахалазии. В период с 2017 по 2024 гг. было выполнено 21 оперативное вмешательство у 21 ребенка с ахалазией (средний возраст 14,3 года). Диагноз был верифицирован на основании комплексного обследования, включающего видеоэзофагогастродуоденоскопию (ВЭГДС), контрастную рентгенографию и манометрию высокого разрешения (выполнена 14 пациентам, 70%). Распределение по манометрическим типам: I тип - два пациента (10%), II тип - десять пациентов (50%), III тип - два пациента (10%). До операции средний балл по шкале Eckardt составил 6,58. Все вмешательства были успешно завершены без осложнений и конверсии. Клиническая эффективность (снижение балла по шкале Eckardt ≤ 3) через три и 12 месяцев наблюдения составила 100%. Эндоскопические признаки рефлюкс-эзофагита спустя три и 12 месяцев после лечения наблюдались у десяти (47,6%) и восьми (38%) детей, а симптоматический рефлюкс был только у пяти пациентов (23%). Таким образом, ПОЭМ продемонстрировала высокую клиническую эффективность (100%) и безопасность в лечении ахалазии пищевода у детей. Частота послеоперационного рефлюкс-эзофагита остается предметом дальнейшего изучения и требует длительного наблюдения.

Esophageal achalasia is a neuromuscular disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and the absence of normal peristalsis in the esophageal body. In the pediatric population, the disease occurs with an incidence of 0.1-0.18 cases per 100,000 children. The “gold standard” of diagnostics is high-resolution manometry (HRM). It not only confirms the diagnosis but also determines the manometric type of achalasia according to the Chicago Classification (version 4.0), which is very important for selecting the correct myotomy length. Traditional treatment methods were balloon dilation (BD) and laparoscopic Heller myotomy (LHM). However, BD is associated with a high risk of recurrence and the need for repeated interventions, while LHM, despite high efficacy (up to 85%), is not without the risk of intraoperative complications and is completely ineffective for the spastic (type III) type. Between 2017 and 2024, 21 surgical interventions were performed in 21 children with achalasia (mean age 14.3 years). The diagnosis was confirmed based on upper endoscopy, timed barium esophagogram and high-resolution manometry (performed in 14 patients, 70%). Distribution by manometric type: Type I - 2 patients (10%), Type II - 10 patients (50%), Type III - 2 patients (10%). The mean pre-operative Eckardt symptom score was 6.58. All procedures were successfully completed without intraoperative complications or conversion. Clinical efficacy (reduction in Eckardt score to ≤ 3) at 3 and 12 months of follow-up was 100%. Endoscopic signs of GERD at 3 and 12 months after treatment were observed in 10 (47,6%) and 8 (38%) children, respectively, while symptomatic reflux bothered only 5 patients (23%). Thus, POEM demonstrated high clinical efficacy (100%) and safety in the treatment of esophageal achalasia in children. The incidence of postoperative reflux esophagitis remains a subject for further study and requires long-term follow-up.

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The authors declare that there are no conflicts of interest present.