title: Laparoscopic myotomy vs endoscopic dilation in the treatment of achalasia.
abstract: BACKGROUND
  The aim of this study was to compare the results obtained in 14 patients with achalasia who underwent laparoscopic Heller's myotomy and Dor's fundoplication with those of 16 patients who had endoscopic dilation.
  
  
  METHODS
  The diagnosis of achalasia was confirmed by manometry, endoscopy, and barium swallow. Esophageal symptoms were quantified before and after treatment using a clinical scale. Six patients had had endoscopic dilation prior to surgery.
  
  
  RESULTS
  Before treatment, the patients in the surgical group complained of more severe dysphagia (median, 5; range, 0-5 vs median 4; range, 3-5) and chest pain (median, 3; range, 0-5 vs median, 1.5; range, 0-5), but both groups were comparable with respect to regurgitation, heartburn, and manometric results. Both groups achieved significant clinical improvement. The severity score decreased from 5 (range, 0-5) to 1 (range, 0-3) (p < 0.05) for dysphagia to solids in the laparoscopic group and from 4 (range, 3-5) to 1 (range, 0-5) (p < 0.05) in the endoscopic group. Lower esophageal sphincter (LES) basal pressure decreased significantly in both groups (from 29.3 to 11.8 mmHg in the laparoscopic group and from 28.9 to 16.5 mmHg in the endoscopic group). After treatment, there were no significant clinical differences between the two groups. Two patients in the surgical group were converted to open surgery.
  
  
  CONCLUSIONS
  Laparoscopic myotomy is as save and effective as endoscopic dilation in the treatment of achalasia.
authors.affiliation: Department of General Surgery, Hospital General Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain. jsuaresa@eresmas.com
authors.forename: J
authors.initials: J
authors.lastname: Suárez
authors.forename: F
authors.initials: F
authors.lastname: Mearin
authors.forename: R
authors.initials: R
authors.lastname: Boque
authors.forename: V
authors.initials: V
authors.lastname: Zanón
authors.forename: J R
authors.initials: JR
authors.lastname: Armengol
authors.forename: J
authors.initials: J
authors.lastname: Pradell
authors.forename: B
authors.initials: B
authors.lastname: Bermejo
authors.forename: A
authors.initials: A
authors.lastname: Nadal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000379:methods*; D004931:Esophageal Achalasia / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D018662:Fundoplication / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged