Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Endoscopic Treatment of Primary Esophageal Motility Disorders

일차성 식도운동질환에서 내시경치료

  • Lee, Joon-Seong (Department of Internal Medicine, Institute for Digestive Research, Soonchunhyang University College of Medicine)
  • 이준성 (순천향대학교 의과대학 내과학교실, 소화기연구소)
  • Published : 2011.06.30
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Abstract

Treatment of primary esophageal motility disorders, particularly achalasia, has developed enormously. The proven treatments for these patients include mostly endoscopic methods. Currently, pneumatic dilatation and laparoscopic myotomy with partial fundoplication are both useful for treating achalasia. A young man with high lower esophageal sphincter pressure might be best indicated for a laparoscopic myotomy with fundoplication, whereas an older patient with a high risk for surgery or vigorous achalasia may for a candidate for an endoscopic botulinum toxin injection. Pneumatic balloon dilatation is the choice of treatment for other cases of achalasia. The best treatment option for a nonachalasia spastic motor disorder of the esophagus may be endoscopic injection of botulinum toxin. In the future, endoscopic injection of neuronal stem cells could be the best treatment option for achalasia.

일차성 식도운동질환, 특히 식도이완불능증에서의 치료는 많은 발전을 해왔다. 이들 환자에서 입증된 치료의 대부분은 내시경적 방법이다. 현재 식도이완불능증에서 내시경적 풍선확장술과 복강경하 근절개술 및 부분 추벽성형술은 둘 모두 유용한 치료법이다. 특히 젊은 연령의 남성에서 높은 하부식도조임근압을 보인다면 복강경하 근절개술 및 부분 위바닥 주름성형술의 가장 좋은 적응증일 것이다. 수술적 고위험군이나 고령, 또는 강력한 식도이완불능증인 경우는 내시경적 보툴리늄 독소 주입법의 좋은 적응증이 될 것이다. 그외의 경우에는 일차치료로 내시경적 풍선확장술이 주된 치료로 이용될 것이다. 식도이완불능증 이외의 경직성식도운동질환에서 가장 좋은 치료법은 현재 내시경적 보툴리늄 독소 주입법일 것이다. 미래에는 신경성줄기세포를 내시경적으로 주입하는 방법이 식도이완불능증의 주된 근본적인 치료법이 될 수 있을 것으로 생각한다.

Keywords

References

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