title: Medium and long-term outcomes after pneumatic dilation or laparoscopic Heller myotomy for achalasia: a meta-analysis.
abstract: Recent randomized studies comparing outcomes after pneumatic dilation (PD) and laparoscopic Heller myotomy (LHM) for the treatment of achalasia are conflicting and limited to short-term follow-up. Our meta-analysis compared the long-term durability of these approaches, with the hypothesis that LHM offers superior long-term remission compared with PD. We identified 36 studies published between 2001 and 2011 with at least 5 years of follow-up. Those studies describing PD included 3211 patients (mean age, 49.8 y). For PD, the mean 5-year remission rate was 61.9% and the mean 10-year remission rate was 47.9%. Overall, 1526 patients (mean age, 46.3 y) were treated with LHM; 83% received a fundoplication. In contrast, the mean 5- and 10-year remission rates after LHM were 76.1% and 79.6%, respectively. Finally, the perforation rate for LHM was twice that of PD (4.8% vs. 2.4%; P<0.05). We conclude that despite a higher frequency of perforation, LHM affords greater long-term durability.
authors.affiliation: Department of Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL 60153, USA.
authors.forename: Cynthia E
authors.initials: CE
authors.lastname: Weber
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Davis
authors.forename: Holly J
authors.initials: HJ
authors.lastname: Kramer
authors.forename: Jeff T
authors.initials: JT
authors.lastname: Gibbs
authors.forename: Lourdes
authors.initials: L
authors.lastname: Robles
authors.forename: Piero Marco
authors.initials: PM
authors.lastname: Fisichella
mesh_terms: D004106:Dilatation / Q000379:methods; D004931:Esophageal Achalasia / Q000503:physiopathology / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies; D012189:Retrospective Studies