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Pneumatic Dilatation or Laparoscopic Cardiomyotomy in the Management of Newly Diagnosed Idiopathic Achalasia

Results of a Randomized Controlled Trial

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Abstract

Background

The most effective therapeutic strategy in newly diagnosed achalasia is yet to be established. Therefore we designed a study in which pneumatic dilatation was compared to laparoscopic cardiomyotomy to which was added a partial posterior fundoplication.

Patients and Results

A series of 51 patients (24 males, mean age 44 years) were randomly allocated to the therapeutic modalities (dilatation = 26, surgery = 25). All patients were followed for at least 12 months, and during that period the pneumatic dilatations strategy had significantly more treatment failures (P = 0.04). Only minor differences emerged between the study groups when symptoms, dysphagia scorings, and quality-of-life assessments were evaluated 12 months after initiation of therapy.

Conclusions

Laparoscopic myotomy was found to be superior to an endoscopic balloon dilatation strategy in the treatment of achalasia when studied during the first 12 months after treatment.

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Authors and Affiliations

  1. Department of General Surgery, Borås Central Hospital, Brämhultsvägen 53, S-501 82, Borås, Sweden

    S. Kostic

  2. Department of Otorhinolaryngology, Sahlgrenska University Hospital, SE-413 45, Gothenburg, Sweden

    M. Ruth

  3. Department of Surgery, Karolinska University Hospital, Huddinge, SE-141 86, Stockholm, Sweden

    A. Kjellin & L. Lundell

  4. Department of Radiology, Sahlgrenska University Hospital, SE-413 45, Gothenburg, Sweden

    M. Andersson

  5. Department of Surgery, Sahlgrenska University Hospital, SE-413 45, Gothenburg, Sweden

    H. Lönroth & E. Johnsson

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  1. S. Kostic
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Correspondence to S. Kostic.

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Kostic, S., Kjellin, A., Ruth, M. et al. Pneumatic Dilatation or Laparoscopic Cardiomyotomy in the Management of Newly Diagnosed Idiopathic Achalasia. World J. Surg. 31, 470–478 (2007). https://doi.org/10.1007/s00268-006-0600-9

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  • DOI: https://doi.org/10.1007/s00268-006-0600-9

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