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Efficacy and safety of laparoscopic Heller’s myotomy versus pneumatic dilatation for achalasia: A systematic review and meta-analysis of randomized controlled trials

  • Systematic review with meta-analysis
  • Published:
Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background and Objectives

Achalasia has several treatment modalities. We aim to compare the efficacy and safety of laparoscopic Heller myotomy (LHM) with those of pneumatic dilatation (PD) in adult patients suffering from achalasia.

Methods

We searched Cochrane CENTRAL, PubMed, Web of Science, SCOPUS and Embase for related clinical trials about patients suffering from achalasia. The quality appraisal and assessment of risk of bias were conducted with GRADE and Cochrane’s risk of bias tool, respectively. Homogeneous and heterogeneous data was analyzed under fixed and random-effects models, respectively.

Results

The pooled analysis of 10 studies showed that PD was associated with a higher rate of remission at three months, one year, three years and five years (RR = 1.25 [1.09, 1.42] (p = 0.001); RR = 1.13 [1.05, 1.20] (p = 0.0004); RR = 1.48 [1.19, 1.82] (p = 0.0003); RR = 1.49 [1.18, 1.89] (p = 0.001)), respectively. LHM was associated with lower number of cases suffering from adverse events, dysphagia and relapses (RR = 0.50 [0.25, 0.98] (p = 0.04); RR = 0.33 [0.16, 0.71] (p = 0.004); RR = 0.38 [0.15, 0.97] (p = 0.04)), respectively. There is no significant difference between both groups regarding the lower esophageal pressure, perforations, remission rate at two years, Eckardt score after one year and reflux.

Conclusion

PD had higher remission rates than LHM at three months, one year and three years, but not at two years or five years. More research is needed to determine whether PD has a significant advantage over LHM in terms of long-term remission rates.

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Data availability

Data is available upon contacting the corresponding author.

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Authors and Affiliations

  1. Division of Gastroenterology, Mountain Vista Medical Center, Mesa, AZ, USA

    Adnan Malik, Shahbaz Qureshi & Abdul Nadir

  2. Airedale General Hospital, West Yorkshire, UK

    Muhammad Imran Malik

  3. Center for Advanced Therapeutic Endoscopy Centura Health, Porter Adventist Hospital, Denver, CO, USA

    Douglas G. Adler

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Contributions

AM: conceptualization, methodology, formal analysis, writing original draft, methodology and review and editing. SQ: formal analysis, methodology and writing original draft. AN: methodology, writing, editing and data curation. MIM: methodology, writing original manuscript and review and editing. DGA: supervision, writing and editing the manuscript

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Correspondence to Douglas G. Adler.

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Malik, A., Qureshi, S., Nadir, A. et al. Efficacy and safety of laparoscopic Heller’s myotomy versus pneumatic dilatation for achalasia: A systematic review and meta-analysis of randomized controlled trials. Indian J Gastroenterol (2024). https://doi.org/10.1007/s12664-023-01497-8

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