Recurrent achalasia treated with Heller myotomy: a review of the literature.
OBJECTIVE
To evaluate the efficacy and safety of Heller myotomy (HM) for recurrent achlasia, performed after different methods of first-line treatment.


METHODS
We searched for studies published in PubMed from 1966 to March 2008 on treatment of recurrent achalasia with HM after failure with different methods of first-line treatment. The efficacy of HM was assessed by a pooled estimate of response rate with individual studies weighted proportionally to sample size.


RESULTS
Sixteen studies were eligible and included in the review. The results showed that HM has a better remission rate for recurrent achalasia after failure of HM [weighted mean (SD)] of 86.9% (21.8%) compared with 81.6% (23.8%) for pneumatic dilatation (PD). One study evaluated the efficacy of HM after failure of PD combined with botulinum toxin injection (83%). The most common complications were perforation and gastroesophageal reflux.


CONCLUSIONS
HM has the best efficacy in patients with recurrent achlasia who were treated with HM as first-line treatment. Future studies should focus on how to increase the success rate and decrease the complications of HM.
Wang
Lan
L
The First Affiliated Hospital, Medical College, Zhejiang University, Zhejiang Province, China.
Li
You-Ming
YM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D004931:Esophageal Achalasia / Q000601:surgery*; D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D016896:Treatment Outcome; D055815:Young Adult