title: Comparative Study Between Laparoscopic Heller Myotomy Versus Pneumatic Dilatation for Treatment of Early Achalasia: A Prospective Randomized Study.
abstract: BACKGROUND
  Achalasia is an incurable primary motor disorder of the esophagus. The best treatment modality for achalasia is still controversial. This study compared the short- and intermediate-term outcome between endoscopic pneumatic dilatation (EPD) versus laparoscopic esophageal myotomy (LEM) for the management of adult patients with early-stage achalasia.
  
  
  METHODS
  This was a prospective randomized controlled study of adult patients (20-50 years old) who presented with early-stage achalasia (esophageal diameter of <3.5 cm on contrast esophagography). Patients were classified into two groups according to the method of management: Group A patients were treated with LEM, whereas Group B patients were treated with EPD. Follow-up evaluations were conducted at 1 week, 3 months, 6 months, and then 1 year.
  
  
  RESULTS
  In total, 50 patients were managed for a manometrically confirmed diagnosis of achalasia. The median age of presentation was 31.5 years, with a male-to-female ratio of 0.4:1. Both groups were comparable regarding patient demographics and preoperative severity of the condition. The rate of symptoms relief was 76% in EPD compared with 96% in LEM (P=.04). There was a significant lowering of lower esophageal sphincter in the LEM group (P=.0001). Perforation of the esophagus occurred in 8% of the patients during EPD, whereas mucosal tears occurred in 4% of the patients during LEM. Reflux symptoms developed in 28% and 16% of the patients in the EPD and LEM groups, respectively.
  
  
  CONCLUSIONS
  LEM was more effective clinically and manometrically for patients with early-stage achalasia than EPD. There was no significant difference between the two procedures regarding complications.
authors.affiliation: Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt .
authors.forename: Emad
authors.initials: E
authors.lastname: Hamdy
authors.affiliation: Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt .
authors.forename: Ayman
authors.initials: A
authors.lastname: El Nakeeb
authors.affiliation: Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt .
authors.forename: Ehab
authors.initials: E
authors.lastname: El Hanfy
authors.affiliation: Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt .
authors.forename: Mohamed
authors.initials: M
authors.lastname: El Hemaly
authors.affiliation: Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt .
authors.forename: Tarek
authors.initials: T
authors.lastname: Salah
authors.affiliation: Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt .
authors.forename: Hosam
authors.initials: H
authors.lastname: Hamed
authors.affiliation: Gastroenterology Surgical Center, Mansoura University , Mansoura, Egypt .
authors.forename: Nabil Gad
authors.initials: NG
authors.lastname: El Hak
mesh_terms: D000328:Adult; D004106:Dilatation; D004931:Esophageal Achalasia / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult