AN ALTERNATIVE TO THE GOLD STANDARD IN THE SURGICAL TREATMENT OF ACHALASIA CARDIA

The purpose of this study is to compare the results of treatment for achalasia cardia by Heller myotomy and peroral endoscopic myotomy. Subjects and methods. To conduct a comparative assessment of the results of treatment of patients with achalasia cardia by Heller myotomy and Dor fundoplication and peroral endoscopic myotomy, we analyzed the results of treatment of 65 (100.0%) patients who received the treatment at the Multidisciplinary Surgical Department of the National Medical Center «University Clinic» of the Zaporizhzhya State Medical and Pharmaceutical University and Zaporizhzhia Regional Clinical Hospital for 2019–2023. The postoperative observation period was one year. The postoperative follow-up period lasted one year. For a comparative assessment of treatment outcomes, all 65 patients (100.0%) were divided into two groups: group A consisted of 30 patients (46.2%) who underwent surgical treatment using the laparoscopic Heller myotomy with Dor fundoplication technique; group B included 35 patients (53.8%) treated using the peroral endoscopic myotomy (POEM) method. Results. Analysis of treatment outcomes for achalasia cardia based on the Eckardt scale demonstrated significant effectiveness in both groups. In the Heller myotomy group, the score decreased from 7.6 ± 1.1 before surgery to 3.3 ± 0.4 after surgery (p < 0.0001, U = 466.0). Similarly, in the peroral endoscopic myotomy (POEM) group, the score decreased from 7.8 ± 0.7 before surgery to 3.0 ± 0.4 after surgery (p < 0.0001, U = 492.0). These results indicate the equivalent effectiveness of both methods (p = 0.8032, U = 785.0). In the Heller myotomy group, recurrences were observed in 2 patients (6.7%), while in the POEM group, 2 cases (5.7%) of reflux esophagitis were detected post-treatment. However, these results were not statistically significant in either case (p = 0.1944, U = 495.0 and p = 0.6979, U = 490.0, respectively). Conclusion Oral endoscopic myotomy is a modern and minimally traumatic method of treating achalasia cardia, which can compete with Heller cardiomyotomy and can be considered as an effective alternative.