Efficacy of surgical or endoscopic treatment of idiopathic achalasia: a systematic review and network meta-analysis

Mundre, Pradeep; Black, Christopher J; Mohammed, Noor; Ford, Alexander C

doi:10.1016/s2468-1253(20)30296-x

Cited by 59 publications

(51 citation statements)

References 52 publications

(80 reference statements)

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“…42 Two recent network meta-analysis showed LHM and POEM having comparable efficacy overall with achalasia, and PD as performing less successfully. 43,44 Recent national society guidelines have suggested that LHM, PD, and POEM are effective treatment options for type I and type II achalasia, with a preference for a tailored and longer myotomy for type III achalasia. 45,46 As the ability for HRM to subtype achalasia continues to evolve, the potential for tailoring treatment for each patient with this disease will undoubtedly advance as well.…”

Section: Clinical Considerations and Therapeutic Optionsmentioning

confidence: 99%

“…A meta‐analysis has also revealed POEM to have a higher instance of gastroesophageal reflux disease (GERD) metrics than LHM, which is typically combined with a Dor or Toupet fundoplication 42 . Two recent network meta‐analysis showed LHM and POEM having comparable efficacy overall with achalasia, and PD as performing less successfully 43,44 …”

Section: Additional Considerationsmentioning

confidence: 99%

See 1 more Smart Citation

Chicago Classification update (version 4.0): Technical review on diagnostic criteria for achalasia

Khan¹,

Yadlapati

Gonlachanvit

et al. 2021

Neurogastroenterology Motil

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The Chicago Classification has gained worldwide acceptance in categorizing esophageal motility disorders using esophageal high-resolution manometry (HRM), with the first three versions published between 2009 and 2015. [1][2][3] The recently developed Chicago Classification version 4.0 (CCv4.0) expanded upon prior adaptations with the assistance of an international HRM Working Group composed of 52 diverse members using formal validated methodologies over two years. 4 The 52 members were assigned to seven subgroups: standard HRM protocol, achalasia, esophagogastric junction outflow obstruction (EGJOO), distal esophageal spasm (DES), hypercontractile esophagus

show abstract

Section: Clinical Considerations and Therapeutic Optionsmentioning

confidence: 99%

Section: Additional Considerationsmentioning

confidence: 99%

Chicago Classification update (version 4.0): Technical review on diagnostic criteria for achalasia

Khan¹,

Yadlapati

Gonlachanvit

et al. 2021

Neurogastroenterology Motil

View full text Add to dashboard Cite

show abstract

“…2 Currently, treatment failure rates are estimated in the range of 20-25% after endoscopic PD and 10-20% after laparoscopic HM. [3][4][5][6][7] Symptom recurrence after PD is related to lack of uniform protocols, operator's experience, and patient related factors. Recognized causes of surgical failure are an incomplete distal myotomy, twisting or mediastinal herniation of the fundoplication, reflux esophagitis, late fibrosis at the myotomy site, and dolichomegaesophagus.…”

Section: Introductionmentioning

confidence: 99%

Revisional Therapy for Recurrent Symptoms After Heller Myotomy for Achalasia

Milito

Siboni

Lovece

et al. 2022

Journal of Gastrointestinal Surgery

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Purpose Symptom recurrence after initial surgical management of esophageal achalasia occurs in 10–25% of patients. The aim of this study was to analyze safety and efficacy of revisional therapy after failed Heller myotomy (HM). Methods A retrospective review of a prospective database was performed searching for patients with recurrent symptoms after primary surgical therapy for achalasia. Patients with previously failed HM were considered for the final analysis. The Foregut questionnaire, and the Atkinson and Eckardt scales were used to assess severity of symptoms. Objective investigations routinely included upper gastrointestinal endoscopy and barium swallow study. Redo treatments consisted of endoscopic pneumatic dilation (PD), laparoscopic HM, hybrid Ivor Lewis esophagectomy, or stapled cardioplasty. A yearly clinical and endoscopic follow-up was scheduled in all patients. Results Over a 20-year period, 26 patients with a median age of 66 years (IQR 19.5) underwent revisional therapy after failed HM for achalasia at a tertiary-care university hospital. The median time after index procedure was 10 years (IQR 21). Revisional therapy consisted of endoscopic pneumatic dilation (n=13), laparoscopic HM and fundoplication (n=10), esophagectomy (n=2), and stapled cardioplasty and fundoplication (n=1). Nine (34.6%) of these patients required further endoscopic or surgical treatments. There was no mortality, and the overall complication rate was 7.7%. At a median follow-up of 42 months (range 10–149), a significant decrease of dysphagia, regurgitation, chest pain, respiratory symptoms, and median Eckardt score (p<0.05) was noted. Conclusion In specialized and multidisciplinary centers, revisional therapy for achalasia is feasible, safe, and effective.

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“…With over a decade of experience and robust data showing excellent safety and efficacy, peroral endoscopic myotomy (POEM) is now considered as the first line treatment for achalasia cardia. 1 Around 10% of patients with prolonged duration of disease develop advanced achalasia cardia where there can be either excessive dilatation of the esophagus (megaesophagus with diameter > 6 cm) or the axis of the esophagus becomes tortuous taking shape of sigmoid (like sigmoid colon) or both. 2 , 3 Traditionally, esophagectomy has been considered the treatment option for this patient cohort, however, it is fraught with high morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Role of Peroral Endoscopic Myotomy in Advanced Achalasia Cardia With Sigmoid and/or Megaesophagus: A Systematic Review and Metanalysis

Mandavdhare

Kumar‐M

Shukla

et al. 2022

J Neurogastroenterol Motil

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Background/AimsSigmoid esophagus and/or megaesophagus are considered as an advanced stage in the natural history of achalasia cardia. The role of peroral endoscopic myotomy (POEM) in these subset of patients is emerging. We performed a systematic review and metanalysis to study the efficacy of POEM in advanced achalasia cardia with sigmoid and megaesophagus. MethodsA literature search in PubMed and Embase was done from inception till August 3, 2021 to look for studies reporting exclusively on the role of POEM in advanced achalasia cardia with sigmoid and/or megaesophagus. The random effect method with inverse variance approach was used for the computation of pooled prevalence. For 2 groups' analysis of continuous outcome standardized mean difference was used as the summary measure. ResultsEleven studies with 428 patients were included for analysis. The pooled technical and clinical success was 98.27% (95% CI, 96.19-99.22; I 2 = 0%) and 89.38% (95% CI, 84.49-92.86; I 2 = 26%) and on subgroup analysis into sigmoid and megaesophagus it was (98.06% [95% CI, 95.41-99.19; I 2 = 0%], 98.47% [95% CI, 92.72-99.69; I 2 = 0%] and 87.92% [95% CI, 80.68-92.70; I 2 = 37%], 88.36% [95% CI, 62.62-97.17; I 2 = 77%]) respectively. The clinical success at < 1 year and 1-3 year follow-up was 89.37% (95% CI, 82.82-93.61; I 2 = 0%) and 88.66% (95% CI,; I 2 = 46%) respectively. There was a significant reduction in the post-POEM scores with standardized mean difference for Eckardt score (4.81), for integrated relaxation pressure at 4 seconds (1.93), and for lower esophageal sphincter pressure (2.06). ConclusionsPOEM is an effective modality of treatment even in the subset of patients of advanced achalasia cardia with sigmoid and megaesophagus.

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Efficacy of surgical or endoscopic treatment of idiopathic achalasia: a systematic review and network meta-analysis

Abstract: This is a repository copy of Efficacy of surgical or endoscopic treatment of idiopathic achalasia: a systematic review and network meta-analysis.

Cited by 59 publications

References 52 publications

Chicago Classification update (version 4.0): Technical review on diagnostic criteria for achalasia

Chicago Classification update (version 4.0): Technical review on diagnostic criteria for achalasia

Revisional Therapy for Recurrent Symptoms After Heller Myotomy for Achalasia

Role of Peroral Endoscopic Myotomy in Advanced Achalasia Cardia With Sigmoid and/or Megaesophagus: A Systematic Review and Metanalysis

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