Medium and long-term outcomes after pneumatic dilation or laparoscopic Heller myotomy for achalasia: a meta-analysis. Surg Laparosc Endosc Percutan Tech 2012 Aug;22(4):289-96
Date
08/10/2012Pubmed ID
22874676DOI
10.1097/SLE.0b013e31825a2478Scopus ID
2-s2.0-84865511710 (requires institutional sign-in at Scopus site) 60 CitationsAbstract
Recent randomized studies comparing outcomes after pneumatic dilation (PD) and laparoscopic Heller myotomy (LHM) for the treatment of achalasia are conflicting and limited to short-term follow-up. Our meta-analysis compared the long-term durability of these approaches, with the hypothesis that LHM offers superior long-term remission compared with PD. We identified 36 studies published between 2001 and 2011 with at least 5 years of follow-up. Those studies describing PD included 3211 patients (mean age, 49.8 y). For PD, the mean 5-year remission rate was 61.9% and the mean 10-year remission rate was 47.9%. Overall, 1526 patients (mean age, 46.3 y) were treated with LHM; 83% received a fundoplication. In contrast, the mean 5- and 10-year remission rates after LHM were 76.1% and 79.6%, respectively. Finally, the perforation rate for LHM was twice that of PD (4.8% vs. 2.4%; P<0.05). We conclude that despite a higher frequency of perforation, LHM affords greater long-term durability.
Author List
Weber CE, Davis CS, Kramer HJ, Gibbs JT, Robles L, Fisichella PMAuthor
Christopher Stephen Davis MD, MPH Associate Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
DilatationEsophageal Achalasia
Esophageal Sphincter, Lower
Female
Humans
Laparoscopy
Male
Middle Aged
Pressure
Prospective Studies
Retrospective Studies
