title: Laparoscopic Heller's cardiomyotomy achieved lesser recurrent dysphagia with better quality of life when compared with endoscopic balloon dilatation for treatment of achalasia.
abstract: Achalasia is a rare primary motility disorder of esophagus; treatments include endoscopic balloon dilatation (EBD) and laparoscopic Heller's cardiomyotomy (LC). This study compared EBD versus LC for treatment of achalasia with focus on quality of life (QoL) and prevalence of post-treatment gastroesophageal reflux disease. This was a retrospective cohort study of all patients diagnosed with achalasia older than 16 treated with either EBD or LC from January 1998 to April 2008. Patients' demographic data, comorbidities, postintervention GERD symptoms, QoL, recurrence of dysphagia, reintervention rate, hospital stay, and time to resumption of diet were collected. Sixty-eight patients were recruited into the study (EBD n= 50; LC n= 18). A significant improvement in QoL was found in patients undergoing LC (0.917 vs. 0.807, P= 0.006). A higher proportion of patients treated with EBD developed post-treatment gastroesophageal reflux symptoms (60.5% vs. 43.8%) when compared with LC, although statistically insignificant (P= 0.34). Patients treated with balloon dilatation had a greater percentage of recurrence of dysphagia (55.1% vs. 26.7%; P= 0.235) and need of reintervention (42.1% vs. 9.1%; P= 0.045). However, these patients had a shorter median hospital stay (1d [range 0-4]) and earlier resumption of diet (0d [range 0-3]). Although EBD is associated with a quicker perioperative recovery, LC accomplished a better QoL, lower incidence of recurrence of dysphagia, and need of reintervention after treatment for achalasia.
authors.affiliation: Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: S M
authors.initials: SM
authors.lastname: Chan
authors.forename: P W Y
authors.initials: PW
authors.lastname: Chiu
authors.forename: J C Y
authors.initials: JC
authors.lastname: Wu
authors.forename: S M
authors.initials: SM
authors.lastname: Kwan
authors.forename: P Y
authors.initials: PY
authors.lastname: Kwong
authors.forename: K W
authors.initials: KW
authors.lastname: Lam
authors.forename: K K
authors.initials: KK
authors.lastname: Lo
authors.forename: M K M
authors.initials: MK
authors.lastname: Tee
authors.forename: C P
authors.initials: CP
authors.lastname: Wong
authors.forename: A Y B
authors.initials: AY
authors.lastname: Teoh
authors.forename: S K H
authors.initials: SK
authors.lastname: Wong
authors.forename: E K W
authors.initials: EK
authors.lastname: Ng
mesh_terms: D000328:Adult; D002299:Cardia / Q000601:surgery*; D002404:Catheterization / Q000379:methods*; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000517:prevention & control*; D004032:Diet; D004106:Dilatation / Q000379:methods; D004931:Esophageal Achalasia / Q000523:psychology / Q000601:surgery* / Q000628:therapy; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011788:Quality of Life; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome