A systematic review and meta-analysis of the Chinese literature for the treatment of achalasia

Wang, Lan; Li, Youming; Li, Lan; Yu, Chaohui

doi:10.3748/wjg.14.5900

Cited by 26 publications

(17 citation statements)

References 13 publications

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“…Two recent meta-analyses concluded that botulinum toxin injection in patients with achalasia had an excellent safety profile but was slightly less effective than pneumatic dilatation in the short-term and clearly inferior in the longterm [23,24]. Of note, a randomized, controlled trial has shown that the two currently commercially available formulations of botulinum toxin are equally effective but need to be given in different dosages because of variable potency [25].…”

Section: Botulinum Toxin Injectionsmentioning

confidence: 96%

SAGES guidelines for the surgical treatment of esophageal achalasia

et al. 2011

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PreambleThe guidelines for the surgical treatment of esophageal achalasia are a series of systematically developed statements to assist surgeon (and patient) decisions about the appropriate use of minimally invasive techniques for the treatment of achalasia in specific clinical circumstances. It addresses the indications, risks, benefits, outcomes, alternatives, and controversies of the procedures used to treat this condition. The statements included in this guideline are the product of a systematic review of published work on the topic, and the recommendations are explicitly linked to the supporting evidence. The strengths and weaknesses of the available evidence are highlighted, and expert opinion is sought where published evidence lacks depth. DisclaimerClinical practice guidelines are intended to indicate the best available approach to medical conditions as established by a systematic review of available data and expert opinion. The approach suggested may not necessarily be the only acceptable approach given the complexity of the healthcare environment. These guidelines are intended to be flexible, because the surgeon must always choose the approach best suited to the individual patient and variables in existence at the moment of decision. These guidelines are applicable to all physicians who are appropriately credentialed and address the clinical situation in question, regardless of specialty.Guidelines are developed under the auspices of SAGES-the guidelines committee-and are approved by the Board of Governors. The recommendations of each guideline undergo multidisciplinary review and are considered valid at the time of production based on the data available. New developments in medical research and practice pertinent to each guideline are reviewed, and guidelines will be periodically updated. Literature review methodA systematic literature search was performed on MED-LINE in October 2010. The search strategy was limited to adult English language articles and is shown in Fig. 1.We identified 214 relevant articles. The abstracts were reviewed by four committee members (DS, WR, TMF, and GPK) and divided into the following categories:(a) Randomized studies, meta-analyses, and systematic reviews and Other Interventional Techniques (b) Prospective studies (c) Retrospective studies (d) Case reports (e) Review articlesRandomized controlled trials, meta-analyses, and systematic reviews were selected for further review along with prospective and retrospective studies that included at least 50 patients. Studies with smaller samples were considered when additional evidence was lacking. The most recent reviews also were included. All case reports, old reviews, and smaller studies were excluded. According to these exclusion criteria, 102 articles were selected for review. Whenever the available evidence from Level I studies was considered to be adequate, lower evidence level studies were not considered.The reviewers graded the level of evidence and manually searched the bibliography of each article for additional articl...

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Section: Botulinum Toxin Injectionsmentioning

confidence: 96%

SAGES guidelines for the surgical treatment of esophageal achalasia

et al. 2011

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“…A meta-analysis of controlled and uncontrolled studies in the Chinese literature (43 articles with 1791 participants) also showed that myotomy was associated with higher initial and long-term remission rates than pneumatic dilation or botulinum toxin injection. Only 2 studies compared open myotomy with laparoscopic myotomy; there was no difference in remission rate [39] . Since results after any treatment may deteriorate over time, life-long follow-up and objective assessment of the results are recommended.…”

Section: Treatmentmentioning

confidence: 99%

“…More recently, laparoscopic and thoracoscopic techniques have been used to perform myotomy [39,[44][45][46] . The modified Heller approach results in good to excellent relief of symptoms in 70% to 90% of patients with few serious complications.…”

Section: Surgical Myotomymentioning

confidence: 99%

Achalasia: A review of Western and Iranian experiences

Mikaeli¹,

Islami²,

Malekzadeh³

2009

WJG

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Achalasia is a primary motor disorder of the eso phagus, in which esophageal emptying is impaired. Diagnosis of achalasia is based on clinical findings. The diagnosis is confirmed by radiographic, endoscopic, and manometric evaluations. Several treatments for achalasia have been introduced. We searched the PubMed Database for original articles and meta analyses about achalasia to summarize the current knowledge regarding this disease, with particular focus on different procedures that are used for treatment of achalasia. We also report the Iranian experience of treatment of this disease, since it could be considered as a model for mediumresource countries. Myotomy, particularly laparoscopic myotomy with fundoplication, i s t h e m o s t e ffe c t i ve t re a t m e n t fo r a c h a l a s i a . Compared to other treatments, however, the initial cost of myotomy is usually higher and the recovery period is longer. When performing myotomy is not indicated or not possible, graded pneumatic dilation with slow rate of balloon inflation seems to be an effective and safe initial alternative. Injection of botulinum toxin into the lower esophageal sphincter before pneumatic dilation may increase remission rates. However, this needs to be confirmed in further studies. Due to lack of adequate information regarding the role of expandable stents in the treatment of achalasia, insertion of stents does not currently seem to be a recommended treatment. In summary, laparoscopic myotomy can be considered as the procedure of choice for treatment of achalasia. Graded pneumatic dilation is an effective alternative when the performance of myotomy is not possible for any reason.

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“…The advantages of balloon dilatation include shorter length of stay, quicker recovery time, and decreased cost [13] . Pneumatic dilatation can be complicated by substernal pain, prolonged epigastric pain, esophageal perforation, aspiration pneumonia, and GERD [13,[16][17][18][19] . Multiple studies suggest that in older children, pneumatic dilation is effective and safe initial treatment for achalasia and may spare children with achalasia an operation [13,14,20] .…”

Section: Pneumatic Dilatationmentioning

confidence: 99%

Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management

Franklin

Petrosyan

Kane

2014

WJGE

114

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Achalasia is an esophageal motility disorder characterized by failure of lower esophageal sphincter (LES) relaxation and is rare in children. The most common symptoms are vomiting, dysphagia, regurgitation, and weight loss. Definitive diagnosis is made with barium swallow study and esophageal manometry. In adults, endoscopic biopsy is recommended to exclude malignancy however; it is not as often indicated in children. Medical management often fails resulting in recurrent symptoms and the ultimate definitive treatment is surgical. Laparoscopic Heller myotomy with or without an anti-reflux procedure is the treatment of choice and has become standard of care for children with achalasia. Peroral endoscopic myotomy is a novel therapy utilized with increasing frequency for achalasia treatment in adults. More experience is needed to determine the safety, efficacy, and feasibility of peroral endoscopic myotomy in children.

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A systematic review and meta-analysis of the Chinese literature for the treatment of achalasia

Cited by 26 publications

References 13 publications

SAGES guidelines for the surgical treatment of esophageal achalasia

SAGES guidelines for the surgical treatment of esophageal achalasia

Achalasia: A review of Western and Iranian experiences

Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management

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