<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2444-6483</journal-id>
<journal-title><![CDATA[Endoscopia]]></journal-title>
<abbrev-journal-title><![CDATA[Endoscopia]]></abbrev-journal-title>
<issn>2444-6483</issn>
<publisher>
<publisher-name><![CDATA[Asociación Mexicana de Endoscopia Gastrointestinal A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2444-64832019000600507</article-id>
<article-id pub-id-type="doi">10.24875/end.m19000160</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Evolución del tratamiento de Acalasia en el Hospital General &#8220;Dr. Manuel Gea González&#8221;. Mas allá de los límites, cirugía de tercer espacio]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Vargas-Salgueiro]]></surname>
<given-names><![CDATA[Ayermin Heriberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Topete-González]]></surname>
<given-names><![CDATA[Luis Alberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Fernández-Enríquez]]></surname>
<given-names><![CDATA[Enrique Raúl]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Valdivia-Correa]]></surname>
<given-names><![CDATA[Barbara]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rodríguez-Parra]]></surname>
<given-names><![CDATA[Andrés]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Betancourt-Ferreira]]></surname>
<given-names><![CDATA[Jessica Yazmin]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Santillán-Lomelí]]></surname>
<given-names><![CDATA[Ivette]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Jordán-García]]></surname>
<given-names><![CDATA[Eduardo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[López y López]]></surname>
<given-names><![CDATA[Miguel Ángel]]></given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Montijo-Barrios]]></surname>
<given-names><![CDATA[Ericka]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rivera]]></surname>
<given-names><![CDATA[Andy Gabriel]]></given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Madrigal-Téllez]]></surname>
<given-names><![CDATA[Marco Antonio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Herrera-Esquivel]]></surname>
<given-names><![CDATA[José de Jesús]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Delano-Alonso]]></surname>
<given-names><![CDATA[Roberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Valenzuela-Salazar]]></surname>
<given-names><![CDATA[Carlos]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[González-Angulo]]></surname>
<given-names><![CDATA[Jaime Alberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Río-Suarez]]></surname>
<given-names><![CDATA[Ignacio Del]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Moreno-Portillo]]></surname>
<given-names><![CDATA[Mucio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital General Dr. Manuel Gea González Departamento de Endoscopía Gastrointestinal ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2019</year>
</pub-date>
<volume>31</volume>
<fpage>507</fpage>
<lpage>515</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2444-64832019000600507&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2444-64832019000600507&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2444-64832019000600507&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción: La acalasia es un trastorno motor primario del esófago infrecuente en la población, afecta a una de cada 100,000 personas año y se caracteriza por la ausencia de peristalsis esofágica y relajación incompleta del esfínter esofágico inferior en relación a la deglución o frecuentemente en asociación con un esfínter esofágico inferior hipertenso.1 Los síntomas de presentación más comunes son la disfagia, regurgitación de alimento no digerido, pérdida de peso, dolor torácico y síntomas respiratorios como tos nocturna, aspiración y neumonía. El tratamiento de la acalasia ha evolucionado en relación al mejor entendimiento de la fisiopatología de la enfermedad con herramientas como la manometría de alta resolución, así como al desarrollo de nuevas técnicas quirúrgicas de cirugía de mínima invasión además del recientemente surgimiento de la cirugía de tercer espacio2. El desarrollo y la difusión de técnicas de cirugía de mínima invasión en los últimos 30 años ha cambiado de forma radical el algoritmo de manejo de la acalasia. En 2010 comienza la historia de la cirugía de tercer espacio con la presentación de Inoue &amp; colls con 17 casos consecutivos de miotomía endoscópica per oral POEM para el tratamiento de acalasia. Objetivo. En el presente trabajo presentamos una reseña histórica del manejo de la acalasia en el hospital general &#8220;Dr. Manuel Gea González&#8221; hasta la actualidad con la revisión retrospectiva de resultados de la cirugía CMI y la comparativa con los resultados obtenidos hasta el momento con la cirugía de tercer espacio.  Materiales y métodos: Se realizó una revisión retrospectiva de todos los pacientes con diagnóstico de acalasia durante 10 años (2007-2017), tratados en la unidad de cirugía endoscópica mediante CMI. Los criterios de inclusión fueron: diagnóstico confirmado de acalasia y posterior manejo quirúrgico. El seguimiento a 1 mes fue el siguiente criterio de inclusión. El siguiente grupo analizado fue de 11 pacientes en un periodo de 3 años (2016-1019) con diagnóstico de acalasia y posteriormente tratados mediante cirugía de tercer espacio (POEM). Se presentan los resultados comparativos.  Resultados: De los 58 pacientes del grupo de CMI el promedio de edad fue 44, con un promedio de Eckardt de 7 siendo los síntomas más prevalentes la disfagia y regurgitación. Mediante la técnica estándar de Heller con procedimiento antirreflujo se logro una mejoría importante en la escala de Eckardt de 2 (1-4). Se presentaron complicaciones en 8.6% de los casos. Los síntomas de reflujo se presentaron en 10% de los pacientes. En el grupo de POEM la edad promedio de los pacientes fue mayor 63 años. La escala de Eckardt mejoró de 8 a 1 posterior al procedimiento y no se presentaron complicaciones inherentes al procedimiento. El enfisema subcutáneo fue el hallazgo más común posterior al procedimiento.  Conclusión.: Hasta la fecha con al rededor de 6,000 procedimientos realizados a nivel mundial la cirugía de tercer espacio se ha convertido en el método menos invasivo y con resultados que similares a los obtenidos con MIS(Minimally invasive surgery). Aun con controversias a definir en cuanto a la técnica, la miotomía endoscópica se perfila para convertirse el tratamiento de elección en acalasia.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction: Achalasia is a primary motor disorder of the esophagus infrequent in the population, affects one in 100,000 people year and is characterized by the absence of esophageal peristalsis and incomplete relaxation of the lower esophageal sphincter in relation to swallowing or frequently in association with a sphincter lower esophageal hypertensive. The most common presentation symptoms are dysphagia, regurgitation of undigested food, weight loss, chest pain and respiratory symptoms such as night cough, aspiration and pneumonia.The treatment of achalasia has evolved in relation to the better understanding of the pathophysiology of the disease with tools such as high resolution manometry, as well as the development of new surgical techniques of minimally invasive surgery in addition to the recent emergence of third-space surgery. The development and diffusion of minimally invasive surgery techniques in the last 30 years has radically changed the algorithm of achalasia management. In 2010 the history of third-space surgery begins with the presentation of Inoue &amp; colls with 17 consecutive cases of endoscopic myotomy per oral POEM for the treatment of achalasia.  Objective: In the present work we present a historical review of the management of achalasia in the general hospital &#8220;Dr. Manuel Gea González &#8220;until now with the retrospective review of the results of the CMI surgery and the comparison with the results obtained so far with third space surgery.  Materials and methods: We performed a retrospective review of all patients diagnosed with achalasia for 10 years (2007-2017), treated in the endoscopic surgery unit using CMI. The inclusion criteria were: confirmed diagnosis of achalasia and subsequent surgical management. The 1-month follow-up was the next inclusion criterion. The next group analyzed was 11 patients in a period of 3 years (2016-1019) with a diagnosis of achalasia and subsequently treated by third-space surgery (POEM). The comparative results are presented.  Results: Of the 58 patients in the CMI group, the average age was 44, with an average of Eckardt of 7 being the most prevalent symptoms of dysphagia and regurgitation. Through the standard technique of Heller with antireflux procedure, an important improvement was achieved in the Eckardt scale of 2 (1-4). Complications occurred in 8.6% of cases. Reflux symptoms occurred in 10% of patients. In the POEM group, the average age of the patients was 63 years. The Eckardt scale improved from 8 to 1 after the procedure and there were no complications inherent to the procedure. Subcutaneous emphysema was the most common finding after the procedure.  Conclusion: To date, with around 6,000 procedures performed worldwide, third-space surgery has become the least invasive method with results similar to those obtained with MIS (Minimally invasive surgery). Even with controversies to be defined in terms of technique, endoscopic myotomy is emerging to become the treatment of choice in achalasia.]]></p></abstract>
</article-meta>
</front><back>
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<article-title xml:lang=""><![CDATA[Clinical Outcomes and Safety of Partial Full-Thickness Myotomy versus Circular Muscle Myotomy in Peroral Endoscopic Myotomy for Achalasia Patients]]></article-title>
<source><![CDATA[Gastroenterology Research and Practice]]></source>
<year>2017</year>
</nlm-citation>
</ref>
</ref-list>
</back>
</article>
