Meta-Analysis of Randomized and Controlled Treatment Trials for Achalasia

Wang, Lan; Li, Youming; Li, Lan

doi:10.1007/s10620-008-0637-8

Cited by 133 publications

(44 citation statements)

References 37 publications

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“…showed an association between larger volume of surgery and improved perioperative outcome [14] due to a steep learning curve for LHM [4], [7], [8]. Long–term efficacy of LHM is reported to range between 88% and 95% [6], [15], [16], [17], [18], [19]. PD, when applied in a graded fashion, has been shown to be non-inferior in efficacy to LHM in the short term [15], [16].…”

Section: Discussionmentioning

confidence: 99%

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Management of achalasia in the UK, do we need new guidelines?

Kafsi

Foliaki

Dehn

et al. 2016

Annals of Medicine &Amp; Surgery

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AimIt is recommended that management of complex benign upper gastrointestinal pathology is discussed at multi disciplinary team (MDT) meetings. American College of Gastroenterology (ACG) guidelines further recommend that treatment delivery is provided by high volume centres, with objective post-procedural investigations, in order to improve patient outcomes. We aimed to survey the current UK practice in the management of achalasia.Methods443 Upper gastrointestinal (UGI) specialist surgeons throughout the UK were sent a surveymonkey.com questionnaire about the management of achalasia.Results100 responses were received. The majority of patients with achalasia are referred directly to surgeons (80%) and only 15% of units have a MDT meeting for discussing such patients. Diagnosis was mainly with oesophagogastroduodenoscopy (OGD) and contrast swallow, and only 61% of units have access to high resolution manometry (HRM). 89% of younger patients were offered surgery initially, whilst in the elderly surgery was offered as first line treatment in 55%. Partial fundoplication was carried out by 91% of responders as part of the operation, and 58% responders carry out an intraoperative OGD. The average number of operations carried out per annum is 4 per responder. Most responders (66%) did not perform routine post-intervention investigations and follow-up varied from none to lifelong.ConclusionDiagnosis and management of achalasia within the UK is relatively standardised, although there remains limited access to HRM. Discussion at benign MDTs however is poor and follow-up differs widely. UK guidelines may help to make these more uniform.

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Section: Discussionmentioning

confidence: 99%

“…Long–term efficacy of LHM is reported to range between 88% and 95% [6], [15], [16], [17], [18], [19]. PD, when applied in a graded fashion, has been shown to be non-inferior in efficacy to LHM in the short term [15], [16]. A recent meta-analysis suggests that long-term results however are in favour of surgery [17].…”

Section: Discussionmentioning

confidence: 99%

Management of achalasia in the UK, do we need new guidelines?

Kafsi

Foliaki

Dehn

et al. 2016

Annals of Medicine &Amp; Surgery

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“…A recent Cochrane review of six randomized controlled trials including 178 patients evaluated symptom recurrence after esophageal dilation versus endoscopic botulinum toxin A injection at one, six, and 12 months after treatment. Thirty percent of patients undergoing dilation experienced symptom recurrence and treatment failure at 12 months versus 74% of patients who received botulinum toxin A 42. Furthermore, a systematic review and meta-analysis of 105 papers that reported on 761 patients with achalasia who underwent endoscopic treatment with esophageal dilation or botulinum toxin A showed that symptom relief was better for dilation, and the necessity for further treatment was significantly reduced 43…”

Section: Endoscopic Therapiesmentioning

confidence: 99%

Management of achalasia

L¹,

Chiaverina²,

Cacciotella³

et al. 2011

CEG

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Several theories on the etiology and pathophysiology of achalasia have been reported but, to date, it is widely accepted that loss of peristalsis and absence of swallow-induced relaxation of the lower esophageal sphincter are the main functional abnormalities. Treatment of achalasia often aims to alleviate the symptoms of achalasia and not to correct the underlying disorder. Medical therapy has poor efficacy, so patients who are good surgical candidates should be offered either laparoscopic myotomy or pneumatic balloon dilatation. Their own preference should be included in the decision-making process, and treatment should meet the local expertise with these procedures. Laparoscopic surgical esophagomyotomy is a safe and effective modality. It can be considered as initial management or as secondary treatment if the patient does not respond to less invasive modalities. Pneumatic dilatation has proven to be a safe, effective, and durable modality of treatment when performed by experienced individuals, and appears to be the most cost-effective alternative. For patients with multiple comorbidities and for elderly patients, who are not good surgical candidates, endoscopic injection of botulinum toxin should be considered a safe and effective procedure. However, its positive effect diminishes over time, and the need for multiple repeated sessions must be taken into consideration. In the management of patients with achalasia, nutritional aspects play an important role. When lifestyle changes are insufficient, it is necessary to proceed to percutaneous gastrostomy under radiological guidance. In the future, intraluminal myotomy or endoscopic mucosectomy will possibly be an option. Further studies are needed to investigate the role of immunosuppressive therapies in those cases in which an autoimmune etiology is suspected.

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“…showed that there were significant differences in remission rate (laparoscopic myotomy 95.0% vs. pneumatic dilation 77.8%, P = 0.001) and relapse rate (laparoscopic myotomy 5.1% vs. pneumatic dilation 35.71%, P = 0.007), indicating that laparoscopic myotomy offered better clinical result than pneumatic dilation. [13] However, this meta-analysis had been challenged by a large and more recent randomized prospective trial, where Boeckxstaens et al . showed that after 2 years of follow-up, LHM, as compared with PD, was not associated with superior rates of therapeutic success.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of pneumatic dilatation in Saudi achalasia patients

Aljebreen

Samarkandi

Al-Harbi

et al. 2014

Saudi J Gastroenterol

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Background/Aims:Pneumatic dilatation (PD) is one of the effective treatments of achalasia. The aim of this study was to evaluate the efficacy of pneumatic dilation and patient satisfaction in Saudi achalasia patients.Patients and Methods:We have retrospectively recruited patients with confirmed achalasia, who underwent at least one dilatation session from January 1990 to January 2010 at a single tertiary center. Symptoms, including weight loss, dysphagia, retrosternal pain, and regurgitation, were assessed with the use of the Eckardt score (which ranges from 0 to 12, with higher scores indicating more pronounced symptoms). All patients were called and asked about their Eckardt score in addition to their satisfaction score post the dilatation procedure. The primary outcome was therapeutic success (Eckardt score ≤ 3) and patient satisfaction at the time of their calls. The secondary outcomes included the need for retreatment and the rate of complications.Results:A total of 29 patients were included, with a mean age of 40.30 (95% CI: 36.1-44.6) and 55.2% of them were males. The mean of the pre-dilatation Eckardt score was 8.3 (95% CI: 7.2-9.4), which dropped to 2.59 (95% CI: 1.7-3.5) after PD (P < 0.01) with a clinical remission of 76.7% after the first dilatation and a total failure in two patients (7%) after the third dilatation. The mean number of dilatations was 1.3 (95% CI: 1.1-1.5) where 50.7% required one dilatation, 19.2% required two dilatations, and 30.1% required three dilatations. The mean of the symptoms-free period was 53.4 months (SD 52.7, range 1-180) with symptoms recurring in 35% of patients within 2 years. The mean of post-PD patient satisfaction was 7.45 (95% CI: 6.2-8.7). Perforation, which was treated conservatively, occurred in one patient (3.5%), whereas bleeding occurred in two patients (7%). Age or gender was not found to be a predictor of Eckardt score improvement on multivariate linear regression analysis.Conclusion:PD is an efficacious procedure in Saudi achalasia patients with a very good overall patient satisfaction with 53.4 months of symptoms-free period after a successful dilatation.

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Meta-Analysis of Randomized and Controlled Treatment Trials for Achalasia

Cited by 133 publications

References 37 publications

Management of achalasia in the UK, do we need new guidelines?

Management of achalasia in the UK, do we need new guidelines?

Management of achalasia

Efficacy of pneumatic dilatation in Saudi achalasia patients

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