Is Heller Myotomy Better than Balloon Dilation? A Meta-Analysis

Illés, Anita; Farkas, Nelli; Hegyi, Péter; Garami, András; Szabó, Imre; Solymár, Margit; Pétervári, Erika; Balaskó, Márta; Pár, Gabriella; Patrícia, Silvia; Bajor, Judit; Szücs, Ákos; Czimmer, József; Szemes, Kata; Vincze, Áron

doi:10.15403/jgld.2014.1121.262.myo

Cited by 14 publications

(8 citation statements)

References 34 publications

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“…Historically, HM has been the gold standard treatment for achalasia [12 -18]. HM improves symptoms in 89 % of patients, and combined with fundoplication, is a very safe operation with a mortality rate of 0.1 % [19]. Since 2008, POEM has proven its efficacy in the treatment of achalasia and it is now considered an alternative first-line therapy by many.…”

Section: Discussionmentioning

confidence: 99%

How does per-oral endoscopic myotomy compare to Heller myotomy? The Latin American perspective

et al. 2020

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Background and study aims Both Heller myotomy (HM) and per-oral endoscopic myotomy (POEM) are efficacious therapies for achalasia. The efficacy and safety of POEM vs HM in Latin America and specifically in patients with Chagas disease is unknown. Patients and methods Consecutive patients undergoing either HM or POEM for achalasia were included from nine Latin American centers in a prospective registry over 5 years. Technical success was defined as undergoing a successful myotomy. Clinical success was defined as achieving an Eckardt score < 3. Data on demographics, procedure info, Eckardt score, and adverse events (AEs) were collected. Student’s t test, Chi squared, and logistic regression analyses were conducted. Results One hundred thirty-three patients were included (59 male; 44 %; mean age 47). POEM was performed in 69 patients, HM in 64 patients. A total of 35 patients had Chagas disease, 17 of 69 in the POEM group, 18 of 64 in the HM group. Both groups had significant reduction in Eckardt scores (P < 0.00001), but successful initial therapy was significantly higher in the POEM group compared to the HM group (P = 0.01304). AEs were similar in both group (17 % vs 14 %) and consisted of pneumothorax (n = 3 vs 2), bleeding requiring transfusion (n = 3 vs 2), and mediastinitis (n = 3 vs 1). Hospital stay was longer in the HM group than in the POEM group (P < 0.00001). In the Chagas subgroup, post-procedure Eckardt score in the POEM group was significantly reduced by 5.71 points (P < 0.00001) versus 1.56 points in the HM group (P = 0.042793). Conclusion Both HM and POEM are efficacious for achalasia, but POEM was associated with higher initial therapy success and shorter hospital stay in Latin America. In Chagas patients with achalasia, POEM was significantly more effective than HM.

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Section: Discussionmentioning

confidence: 99%

How does per-oral endoscopic myotomy compare to Heller myotomy? The Latin American perspective

et al. 2020

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“…Thus, according to the results of one of the prospective multicenter randomized trials, 2 years after LHM, 10% of patients developed significant recurrent symptoms of AC [12]. According to the data of the meta-analysis conducted by Illés A et al (2017), the effectiveness of LHM exceeded that of PD by the duration of remission and the reduction in the frequency of relapses in AC [9]; whereas according to the results of Cheng JW et al (2017), there were no significant differences between LHM and PD in 2-year and 5-year remission periods. This study showed that any type of treatment may be offered as initial treatment of AC [13].…”

Section: Resultsmentioning

confidence: 99%

“…Cicatrical changes in the gastroesophageal junction and persistent esophageal expansion are indications for surgical treatment with the use of modern laparoscopic and endoscopic techniques. The choice of surgical method depending on manometric subtypes determining the response to treatment is critical [9,10,11].…”

Section: Problem Statement and Analysis Of The Latest Researchmentioning

confidence: 99%

Diagnostics and Minimally Invasive Surgery for Achalasia Cardia

et al. 2018

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The objective of the research was to assess the effectiveness of balloon pneumatic dilation and laparoscopic Heller myotomy in treatment of patients with achalasia cardia. Materials and methods. Twenty-one patients with achalasia cardia were examined and treated using pneumatic balloon dilation and laparoscopic Heller myotomy in the Department of Surgery from January 2016 to April 2018. There were 8 (38.1%) men and 13 (61.9%) women at the age of 28 to 75 years (the average age was (51.47 ± 3.63) years) and disease duration of 1 month to 8 years (the average disease duration was (3.05 ± 0.49) years). Results and discussion. With the help of radiological methods of examination, all the patients were divided into 4 groups according to the esophageal diameter: Group I included 5 (23.8%) patients with the esophagus up to 4-5 cm in diameter; Group II comprised 6 (28.6%) patients with the esophagus up to 4-6 cm in diameter; Group III included 5 (23.8%) patients with the esophagus up to 6-8 cm in diameter; Group IV consisted of 5 (23.8%) patients with the esophagus of more than 8 cm in diameter and an S-shaped configuration. A significant decrease in the diameter of the esophagus according to fluoroscopy (p<0.05) alongside with a decrease in the lower esophageal sphincter pressure according to manometry are indicative in assessing the effectiveness of achalasia cardia treatment after minimally invasive surgery. There were no complications when performing pneumatic balloon dilation and laparoscopic Heller myotomy. Conclusions. In 7 (33.3%) patients, recurrences of achalasia cardia after balloon pneumatic dilation occurred within 2 - 10 months: in 4.7% of patients in Group I and 9.5% of patients in Group II, Group III, and Group IV. In recurrent achalasia cardia, repeated dilation was ineffective. There was performed laparoscopic Heller myotomy with Dor fundoplication, which was effective in 80.0% of cases.

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“…Традиционно наиболее часто используемые варианты лечения -это баллоная пневмокардиодилатация (ПКД) и лапароскопическая миотомия Геллера (ЛМГ) [8].…”

Section: актуальностьunclassified

“…По результатам одного из проспективных, многоцентровых рандомизированных исследований было доказано, что через 2 года у 10 % пациентов наблюдались значительные рецидивные симптомы после ЛМГ [2]. По данным мета-анализа, проведенного [8], эффективность ЛМГ превосходит эффективность ПКД по продолжительности ремиссии и снижению частоты рецидивов, в то время как нет никакой разницы в безопасности развития осложнений между двумя группами лечения [8]. В то время как по данным [4] существенных различий между ЛМГ и ПКД в 2-х летнем и 5-летнем периодах ремиссий не наблюдалось.…”

Section: актуальностьunclassified

Minimally Invasive Treatment for Achalasia of Cardia

Babii¹,

Shevchenkо²,

Prolom³

et al. 2020

Khark. Surg. Sch.

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Summary. Aim. The aim of the work is to evaluate the effectiveness of the minimally invasive technique in the treatment of patients with achalasia of cardia. Materials and methods. In the Department of Surgery of the digestive organs of the Institute from February 2017 to December 2019, comprehensive treatment was examined and carried out using balloon pneumatic dilatation (PD) and Heller laparoscopic myotomy (LMH) in 21 patients with achalasia cardia. Including Men 8 (38.1 %), women 13 (61.9 %) at the age of 28 to 75 years ((51.47 ± 3.63) years). Results and discussion. Using radiation methods for examining the diameter of the esophagus, patients were divided into 4 stages: stage I with an esophagus diameter of up to 4 cm — 5 (23.8 %), stage II — 4–6 cm — 6 (28.6 %), III — 6–8 cm — 5 (23.8 %), IV — more than 8 cm with an S-shaped curved configuration — 5 (23.8 %) patients. The duration of the disease is from one month to 8 years, on average (3.05 ± 0.49) years. The symptomatic treatment efficacy after PD according to the Eckardt scale was 66.7-76.2 %, while after LMH it was 80.0%. The level of relaxation efficiency of the lower esophagus according to manometry was achieved in 81 % of cases. The effectiveness of a barium esophagogram in changing the height of a barium column after a bolus was successful in 76.2-85.7 % of cases. There were no complications when performing balloon PD and LMH. Conclusions. Relapses of achalasia of cardia after balloon PD were established in the period from 2 to 10 months in 33.3 % of cases: 4.7 % in stage I and 9.5 % of cases in stages II, III, IV. With AK relapses in 5 (23.8 %) cases, repeated use of dilatation was ineffective. Performed by LMH and fundoplication Door. The efficiency of balloon PD was 66.7 % after the initial course and 76.2 % after the second course, and the LMH efficiency after the failed PD was 80.0 %.

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Is Heller Myotomy Better than Balloon Dilation? A Meta-Analysis

Cited by 14 publications

References 34 publications

How does per-oral endoscopic myotomy compare to Heller myotomy? The Latin American perspective

How does per-oral endoscopic myotomy compare to Heller myotomy? The Latin American perspective

Diagnostics and Minimally Invasive Surgery for Achalasia Cardia

Minimally Invasive Treatment for Achalasia of Cardia

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