285 The European Achalasia Trial: A Randomized Multi-Centre Trial Comparing Endoscopic Pneumodilation and Laparoscopic Myotomy as Primary Treatment of Idiopathic Achalasia

Boeckxstaens, Guy E.; Annese, Vito; Varannes, Stanislas Bruley des; Chaussade, Stanislas; Costantini, Mario; Elizalde, I.; Romario, Uberto Fumagalli; Gaudric, M; Metman, É.-H.; Rohof, Wout O.; Smout, A. J. P. M.; Tack, Jan; Zaninotto, Giovanni; Busch, Olivier R.

doi:10.1016/s0016-5085(10)60243-0

Cited by 13 publications

(20 citation statements)

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“…Using this technique, the overall risk of perforation is reported to be less than 2%. [75][76][77] Contrast esophagography should be performed for patients with persistent postprocedure pain, tachycardia, fever, or subcutaneous crepitus. Nonoperative management with nasogastric tube decompression and intravenous antibiotics may be used for contained perforations caused by pneumatic dilation.…”

Section: Adverse Events Of Ugi Dilationmentioning

confidence: 99%

Adverse events of upper GI endoscopy

Ben–Menachem¹,

Decker²,

Early³

et al. 2012

Gastrointestinal Endoscopy

316

170

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Section: Adverse Events Of Ugi Dilationmentioning

confidence: 99%

Adverse events of upper GI endoscopy

Ben–Menachem¹,

Decker²,

Early³

et al. 2012

Gastrointestinal Endoscopy

316

170

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“…Although a Dor fundoplication is more commonly reported, the choice of Toupet versus Dor depends on surgeon preference 48. There are very few randomized prospective trials examining esophagomyotomy versus pneumatic dilation 49. One study showed equivalent effectiveness at relieving symptoms initially, but at follow-up it showed those patients who had esophagomyotomy had fewer recurrent symptoms than those who had pneumatic dilation.…”

Section: Surgerymentioning

confidence: 99%

Management of achalasia

L¹,

Chiaverina²,

Cacciotella³

et al. 2011

CEG

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Several theories on the etiology and pathophysiology of achalasia have been reported but, to date, it is widely accepted that loss of peristalsis and absence of swallow-induced relaxation of the lower esophageal sphincter are the main functional abnormalities. Treatment of achalasia often aims to alleviate the symptoms of achalasia and not to correct the underlying disorder. Medical therapy has poor efficacy, so patients who are good surgical candidates should be offered either laparoscopic myotomy or pneumatic balloon dilatation. Their own preference should be included in the decision-making process, and treatment should meet the local expertise with these procedures. Laparoscopic surgical esophagomyotomy is a safe and effective modality. It can be considered as initial management or as secondary treatment if the patient does not respond to less invasive modalities. Pneumatic dilatation has proven to be a safe, effective, and durable modality of treatment when performed by experienced individuals, and appears to be the most cost-effective alternative. For patients with multiple comorbidities and for elderly patients, who are not good surgical candidates, endoscopic injection of botulinum toxin should be considered a safe and effective procedure. However, its positive effect diminishes over time, and the need for multiple repeated sessions must be taken into consideration. In the management of patients with achalasia, nutritional aspects play an important role. When lifestyle changes are insufficient, it is necessary to proceed to percutaneous gastrostomy under radiological guidance. In the future, intraluminal myotomy or endoscopic mucosectomy will possibly be an option. Further studies are needed to investigate the role of immunosuppressive therapies in those cases in which an autoimmune etiology is suspected.

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“…This difference reached statistical significance (p = 0.04) in the per protocol analysis, but not the intention-to-treat analysis (p = 0.09) 48. Most recently, an achalasia trial involving 5 European countries randomized 94 patients to Rigiflex pneumatic dilation (3.0 and 3.5 cm) and 106 to laparoscopic Heller myotomy with Dor fundoplication 49. After 2 years of follow up, both treatments had comparable success rates - 92% for pneumatic dilation and 87% for laparoscopic myotomy.…”

Section: Pneumatic Dilation or Surgical Myotomy?mentioning

confidence: 96%

Achalasia - An Update

Richter

2010

J Neurogastroenterol Motil

101

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Achalasia is an esophageal motility disorder of unknown cause, characterized by aperistalsis of the esophageal body and impaired lower esophageal sphincter relaxation. Patients present at all ages, primarily with dysphagia for solids/liquids and bland regurgitation. The diagnosis is suggested by barium esophagram and confirmed by esophageal manometry. Achalasia cannot be cured. Instead, our goal is to relieve symptoms, improve esophageal emptying and prevent the development of megaesophagus. The most successful therapies are pneumatic dilation and surgical myotomy. The overall success rate of graded pneumatic dilation is 78%, with women and older patients responding best. Laparoscopic myotomy, usually combined with a partial fundoplication, has an overall success rate of 87%. Young patients, especially men, are the best candidates for surgical myotomy. Botulinum toxin injection into the lower esophageal sphincter and smooth muscle relaxants are usually reserved for older patients or those with co-morbid illness. The prognosis for achalasia patients to return to near normal swallowing is good, but the disease is rarely "cured" with a single procedure and intermittent touch-up procedures may be required.

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285 The European Achalasia Trial: A Randomized Multi-Centre Trial Comparing Endoscopic Pneumodilation and Laparoscopic Myotomy as Primary Treatment of Idiopathic Achalasia

Cited by 13 publications

References 0 publications

Adverse events of upper GI endoscopy

Adverse events of upper GI endoscopy

Management of achalasia

Achalasia - An Update

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