Randomized Study Comparing Peroral Endoscopic Myotomy, Botulinum Toxin Injection and Balloon Dilation for Achalasia: One-year Follow-up: ACG International Award

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

“…One of the included studies was a subsequent analysis of an earlier trial, but reported more of the data of interest. 39,40 In total, 26 articles were excluded, leaving nine eligible RCTs, [18][19][20]39,[41][42][43][44][45] containing 911 patients. Seven of these trials were fully published, and two were in abstract form only.…”

“…Seven of these trials were fully published, and two were in abstract form only. 41,42 Detailed characteristics of individual RCTs, including the comparisons made, are provided in Table 2. Technical aspects of each intervention in each trial are reported in Supplementary Table 1 (page 5).…”

“…33 This was why RCTs of Botox were not considered, as patients entering these trials are unlikely to have been suitable for POEM or LHM because of comorbidities or risk. All included studies, except one, 41 stated that the diagnosis was made based on clinical symptoms and patients underwent upper gastrointestinal endoscopy and manometry to facilitate the diagnosis. Although not stated explicitly in this trial, 41 we believe it is likely that manometry and upper gastrointestinal endoscopy were carried out as part of the diagnostic work-up, based on the reported outcomes.…”

“…All included studies, except one, 41 stated that the diagnosis was made based on clinical symptoms and patients underwent upper gastrointestinal endoscopy and manometry to facilitate the diagnosis. Although not stated explicitly in this trial, 41 we believe it is likely that manometry and upper gastrointestinal endoscopy were carried out as part of the diagnostic work-up, based on the reported outcomes. In our analysis all studies, except two, 44,45 excluded patients with previous endoscopic intervention.…”

“…All nine RCTs provided dichotomous data for likelihood of failure of therapy at the last point of follow-up according to a per protocol analysis. [18][19][20]39,[41][42][43][44][45] In this analysis, there were data available for 797 participants, of whom 328 participants were randomised to LHM, 264 to PD, and 205 to POEM. When data were pooled, there was moderate heterogeneity (I 2 = 56.5%).…”