Laparoscopic myotomy vs endoscopic dilation in the treatment of achalasia

Suárez, Jorge; Mearin, Fermı́n; Boque, R.; Zanón, V.; Armengol, J R; Pradell, Jordi; Borras-Bermejo, Blanca; Nadal, Anna

doi:10.1007/s00464-001-0032-4

Cited by 30 publications

(16 citation statements)

References 15 publications

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“…Two randomized studies [23,24] compared the efficacy of pneumatic dilation with laparoscopic myotomy in patients with achalasia. Our meta-analysis showed that there were We used the Jadad scale to assess the quality of trial.…”

Section: Pneumatic Dilation Versus Laparoscopic Myotomymentioning

confidence: 99%

Meta-Analysis of Randomized and Controlled Treatment Trials for Achalasia

Wang

2008

Dig Dis Sci

133

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Pharmacological therapy, botulinum toxin injection, pneumatic dilatation, and surgical myotomy are the primary therapeutic modalities for achalasia, for which laparoscopic myotomy is recommended as state-of-the-art therapy. However, its efficacy and safety remain unclear compared with other approaches in the treatment of achalasia. We searched electronic databases (MEDLINE, EMBASE, Cochrane Central Registry of Controlled Trials, LILACS-Latin American, Caribbean health science literature, and Science Citation Index Expanded) for randomized controlled trials to evaluate which therapeutic measures are temporary and reversible and which measures are definitive and effective by pooling data including remission rate, relapse rate, complications, and adverse effects. Seventeen studies with 761 patients met our inclusion criteria. There was better remission rate in pneumatic dilation than in botulinum toxin injection for initial intervention [relative risk (RR) 2.20, 95% confidence interval (CI) 1.51-3.20], Pneumatic dilation had lower relapse rate than did botulinum toxin injection (RR 0.12, 95% CI 0.04-0.32). Compared with pneumatic dilation, laparoscopic myotomy further increased remission rate (RR 1.48, 95% CI 1.48-1.87), and reduced clinical relapse rate (RR 0.14, 95% CI 0.04-0.58), and there was no difference in complication rate (RR 1.48, 95% CI 0.37-5.99). Based on limited randomized and controlled trials, laparoscopic myotomy is the preferred method for patients with achalasia. Future trials should investigate whether laparoscopic myotomy combined with different modalities of fundoplication is superior to isolated laparoscopic myotomy.

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Section: Pneumatic Dilation Versus Laparoscopic Myotomymentioning

confidence: 99%

Meta-Analysis of Randomized and Controlled Treatment Trials for Achalasia

Wang

2008

Dig Dis Sci

133

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“…Thus, it is well documented in comparative studies that the reduction of postinterventional LES pressure is almost twice as high after HM compared to EBD or EBTI [1,13,15,16]. This results in a more efficient reduction in esophageal outflow obstruction and, subsequently, a better esophageal clearance by gravity.…”

Section: Discussionmentioning

confidence: 79%

Botox, dilation, or myotomy? Clinical outcome of interventional and surgical therapies for achalasia

Gutschow

Töx

Leers

et al. 2010

Langenbecks Arch Surg

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“…Currently modified such that only an anterior myotomy is performed. Excellent results with cardiomyotomy can be achieved in 90% to 95% of patients [3,6,8,9,26,[30][31][32]34,37,38,[52][53][54][55][56]. It provides more reliable relief of dysphagia than pneumatic dilation as it allows accurate division of LES muscle fibers rather than blind disruption [8].…”

Section: Endoscopic Botulinum Toxinmentioning

confidence: 99%

Treatment of achalasia

Kaufman

Oelschlager

2005

Curr Treat Options Gastro

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Achalasia is a primary motility disorder of the esophagus that causes dysphagia. Normal esophageal motility and lower esophageal sphincter (LES) function can not be restored; thus treatment is directed at decreasing the pressure or disrupting the muscle fibers of the LES to allow passage of ingested material. Effective therapy for achalasia can be broadly characterized as surgery based or endoscopy based. Medications (calcium channel blockers and nitrate derivatives) do not provide adequate relief of dysphagia and have substantial side effects, and thus are rarely used as long-term therapy. Botulinum toxin injection, a recently introduced endoscopic therapy, enjoyed much enthusiasm initially but was shown to have only transient effect and is now recommended only for poor operative candidates. The mainstay of therapy remains endoscopic dilation or laparoscopic esophagomyotomy (LEM) combined with an antireflux procedure. We have found that patients who can tolerate a laparoscopic abdominal surgery are best served with an LEM and Toupet (270 degrees ) posterior fundoplication. This provides good or excellent relief of dysphagia in 90% to 95% of patients with very little morbidity.

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Laparoscopic myotomy vs endoscopic dilation in the treatment of achalasia

Abstract: Laparoscopic myotomy is as save and effective as endoscopic dilation in the treatment of achalasia.

Cited by 30 publications

References 15 publications

Meta-Analysis of Randomized and Controlled Treatment Trials for Achalasia

Meta-Analysis of Randomized and Controlled Treatment Trials for Achalasia

Botox, dilation, or myotomy? Clinical outcome of interventional and surgical therapies for achalasia

Treatment of achalasia

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