Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy

Moonen, An; Annese, Vito; Belmans, Ann; Bredenoord, Albert J.; Varannes, Stanislas Bruley des; Costantini, Mario; Dousset, B.; Elizalde, JI; Fumagalli, Uberto; Gaudric, M; Merla, Antonio; Smout, A. J. P. M.; Tack, Jan; Zaninotto, Giovanni; Busch, Olivier R.; Boeckxstaens, Guy E.

doi:10.1136/gutjnl-2015-310602

Cited by 343 publications

(285 citation statements)

References 25 publications

Supporting

Mentioning

253

Contrasting

Unclassified

Order By: Relevance

“…Because of the propensity of this procedure to cause reflux, LHM is usually combined with a partial fundoplication. An extensive literature has compared LHM with pneumatic dilation 51 , culminating in a multi center European randomized controlled trial comparing the two for the treatment of achalasia, which concluded that both approaches were ~90% effective with no statistically significant difference in therapeutic success between them 56,57 . However, that trial (and all preceding trials) did not consider achalasia subtypes in their design or in their assessment of treatment efficacy.…”

Section: Lhm and Pneumatic Dilationmentioning

confidence: 99%

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Kahrilas

Bredenoord

Fox

et al. 2017

Nat Rev Gastroenterol Hepatol

View full text Add to dashboard Cite

High-resolution manometry (HRM), along with the analysis algorithms characterized in the Chicago Classification (CC) first proposed in 2008, have led to a major restructuring of the classification of oesophageal motility disorders. The inherently quantitative output of HRM devices fuelled enthusiastic expectation among motility experts that these advances would add a level of precision to the diagnosis of oesophageal motility disorders that was not previously possible. Nowhere was this advance more evident than in our concept of achalasia, now differentiated into subtypes as a direct result of HRM. Coincident with the assimilation of HRM into clinical practice was the development of a major therapeutic intervention for the management of oesophageal motility disorders, per-oral endoscopic myotomy (POEM). Not only does the POEM procedure provide a therapeutic option for myotomy with reduced morbidity relative to laparoscopic or open myotomy, but it also enables a calibrated intervention that is customized to patient-specific physiology. Together, these develop ments fostered an increasing emphasis on targeting therapy to specific aspects of oesophageal dysfunction, as measured by physiological testing, rather than discrete diagnoses. Again, nowhere is this evolution more evident than in our strategies for managing achalasia. This Consensus Statement examines the effect of HRM on our current understanding of oesophageal motility disorders with a focus on how this technology has affected the diagnosis, epidemiology and management of achalasia and achalasia-like syndromes. on behalf of the International Working Group for Disorders of Gastrointestinal Motility and FunctionAbstract | High-resolution manometry (HRM) and new analysis algorithms, summarized in the Chicago Classification, have led to a restructured classification of oesophageal motility disorders. This advance has led to increased detection of clinically relevant disorders, in particular achalasia. It has become apparent that the cardinal feature of achalasia -impaired lower oesophageal sphincter (LES) relaxation -can occur in several disease phenotypes: without peristalsis (type I), with pan-oesophageal pressurization (type II), with premature (spastic) distal oesophageal contractions (type III), or with preserved peristalsis (outlet obstruction). Furthermore, no manometric pattern is perfectly sensitive or specific for achalasia caused by a myenteric plexopathy, and there is no biomarker for this pathology. Consequently, physiological testing reveals other syndromes not meeting achalasia criteria that also benefit from therapies formerly reserved for achalasia. These findings have become particularly relevant with the development of a minimally invasive technique for performing a long oesophageal myotomy, the per-oral endoscopic myotomy (POEM). Optimal management is to render treatment in a phenotype-specific manner; that is, POEM calibrated to patient-specific physiology for spastic achalasia and the spastic disorders, and more conservative strategies...

show abstract

Section: Lhm and Pneumatic Dilationmentioning

confidence: 99%

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Kahrilas

Bredenoord

Fox

et al. 2017

Nat Rev Gastroenterol Hepatol

View full text Add to dashboard Cite

show abstract

“…In the studies by Boeckxstaens et al [20], Moonen et al [19], Wang et al [21], Tabola et al [22], the authors used the Eckardt score to assess the success rate, while Tabola et al applied the symptom improvement rate by reduction of the Eckardt score and by evaluating the frequency of reintervention. In 4 other studies, symptom evaluation was based on various dysphagia scores.…”

Section: Discussionmentioning

confidence: 99%

“…Perioperative symptom assessment was similar in two studies, Moonen et al [19] and Boeckxstaens et al [20]: the primary outcome of these studies was therapeutic success (a reduction in the Eckardt score to ≤3). Two other studies [21,22] also used Eckardt score to evaluate the therapeutic success.…”

Section: Success Ratementioning

confidence: 98%

“…Six of the eight studies included in the analysis found LHM more effective than EBD, while the remaining two studies showed similar results for both techniques within a follow-up period. The two studies [19,20] which demonstrate that EBD and LHM are similar in effectiveness are large multicenter randomized trials involving many patients. The other six studies are small trials with a smaller sample size.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Illés

Farkas

Hegyi³

et al. 2017

JGLD

View full text Add to dashboard Cite

Background & Aim: Endoscopic balloon dilation (EBD) and laparoscopic Heller myotomy (LHM) are the most commonly performed treatment options for achalasia. Decision between these treatment options is difficult. The aim of this meta-analysis was to evaluate the efficacy of EBD compared to LHM.Methods: The electronic databases PubMed, Embase and Cochrane Controlled Trials Registry were systematically searched for the period between January 1, 1976 and December 31, 2015. Meta-analysis was performed using the PICOS (problem, intervention, comparison, outcome, study design) format. Efficacy and safety of EBD were compared to LHM. Forest plot analyses were used to illustrate the success rate, perforation rate and post-procedural gastroesophageal reflux.Results: Using the search strategy, eight studies met the selection criteria and were included in the meta-analysis. The total number of patients included was 749 (360 in the EBD group and 389 in the LHM group). The success rate was lower in the EBD group than in the LHM group (OR=0.486; CI: 0.304-0.779; p=0.003). The rate of perforation did not differ significantly between the EBD and LHM group (RR= 0.635, CI: 0.340-1.186, p=0.154). The incidence of post-procedural symptomatic gastroesophageal reflux did not differ between the two treatment groups (RR=0.663, CI: 0.328-1.343, p=0.254).Conclusion: Our data suggest that the efficacy of LHM is superior to that of EBD, while there is no difference in safety between the two treatment groups.Abbreviations: EBD: endoscopic balloon dilation; GERD: gastro-esophageal reflux disease; LES: lower esophageal sphincter; LHM: laparascopic Heller myotomy; OR: odds ratio; PICOS: Problem, Intervention, Comparison, Outcome, Study design; POEM: Per Oral Endoscopic Myotomy; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analysis; RR: risk ratio.

show abstract

“…However, 25% of patients treated with pneumatic dilatation required re-dilatations. In subgroup and risk factor analysis, age less than 40 years, pre-existing daily chest pain, a pre-treatment esophageal width of less than 4 cm and type III achalasia were identified as risk factors for treatment failure or requiring re-dilatation in the pneumatic dilatation group (6).…”

Section: Introductionmentioning

confidence: 99%

Peroral endoscopic myotomy (POEM) for treating esophageal motility disorders

Wong¹,

Law²

2017

Ann. Transl. Med.

View full text Add to dashboard Cite

Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy

Abstract: Netherlands trial register (NTR37) and Current Controlled Trials registry (ISRCTN56304564).

Cited by 343 publications

References 25 publications

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

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

Peroral endoscopic myotomy (POEM) for treating esophageal motility disorders

Contact Info

Product

Resources

About