Sharp Nicole E, St Peter Shawn D
Department of Pediatric Surgery, The Children's Mercy Hospital, Kansas City, Missouri, United States.
Department of Surgery, Center for Prospective Trials, The Children's Mercy Hospital, Kansas City, Missouri, United States.
Eur J Pediatr Surg. 2016 Apr;26(2):143-9. doi: 10.1055/s-0035-1544174. Epub 2015 Feb 2.
Achalasia is a rare idiopathic neuromuscular disorder of the esophagus, characterized as a syndrome of impaired relaxation of the lower esophageal sphincter and decreased peristalsis of the esophageal body.
The primary objective is to determine the best first-line treatment for pediatric achalasia based on the consolidation of the current literature that compares outcomes after pneumatic dilatation (PD) versus surgical myotomy (Heller esophagomyotomy [HM]).
A systematic review of English articles using OVID was performed.
OVID was used to search for articles focusing on the treatment of pediatric esophageal achalasia with PD versus HM.
Independent extraction of data was performed by N.E.S using predefined data fields.
Seven articles were included in the systematic review. Techniques of HM and PD varied widely. The best first-line treatment of pediatric achalasia was determined to be HM in two articles, PD in one article, and equal efficacy in one article. Three articles concluded that appropriate initial treatment was determined by the age of the child.
Adequate comparative data are lacking to determine the ideal treatment of pediatric achalasia. Appropriately designed randomized controlled trials with long-term follow-up are needed to determine ideal treatment algorithms in pediatric achalasia.
贲门失弛缓症是一种罕见的食管特发性神经肌肉疾病，其特征为食管下括约肌松弛受损和食管体蠕动减弱综合征。
主要目的是基于对当前文献的整合，比较气囊扩张术（PD）与手术肌切开术（ heller食管肌切开术[HM]）后的结果，以确定小儿贲门失弛缓症的最佳一线治疗方法。
使用OVID对英文文章进行系统综述。
使用OVID搜索聚焦于PD与HM治疗小儿食管贲门失弛缓症的文章。
N.E.S使用预定义数据字段独立提取数据。
系统综述纳入了7篇文章。HM和PD技术差异很大。两篇文章确定小儿贲门失弛缓症的最佳一线治疗方法是HM，一篇文章确定为PD，一篇文章认为疗效相当。三篇文章得出结论，适当的初始治疗取决于患儿年龄。
缺乏足够的比较数据来确定小儿贲门失弛缓症的理想治疗方法。需要设计适当的长期随访随机对照试验来确定小儿贲门失弛缓症的理想治疗方案。
