title: Achalasia: a 13-year, single-centre experience comparing endoscopic balloon dilatation and laparoscopic Heller myotomy.
abstract: BACKGROUND
  Idiopathic achalasia is a non-curable, primary motility disorder of the oesophagus. Most established long-term palliative treatment options are laparoscopic Heller myotomy (LHM) and endoscopic balloon dilatation (BD).
  
  
  OBJECTIVE
  We aimed to compare the outcome of both therapies and the risk of serious complications, defined as perforation or death, in a single-centre series.
  
  
  METHODS
  In this retrospective study, patients with BD or LHM were identified from 1997-2010. The symptom score (modified Zaninotto score) before treatment and at time of interview was evaluated via a telephone questionnaire.
  
  
  RESULTS
  Ninety-nine patients fulfilled the inclusion criteria and treatment was provided with BD-only in 63, surgery-only in 23, BD crossover to surgery in 12, and surgery crossover to BD in one patient. Mean age was 62 years in the BD-only, and 39 years in the surgery-only group. One hundred and fifteen BD were performed on 76 patients with multiple dilatations required in 46 patients (38%). Sixty-four percent of all patients alive (n=81) were interviewed. Satisfactory outcomes were achieved in 79% in the BD group and in 88% in the surgery group, with a mean follow-up of 81 and 69 months, respectively. There was a single perforation in the BD group (0.9%) and no deaths occurred.
  
  
  CONCLUSIONS
  LHM and on-demand BD were safe and within the limitations of our study design both methods appeared similarly effective treatments for achalasia, resulting in a satisfactory outcome in 88% and 79% of patients with a mean follow-up of 69 and 81 months. Serious complications occurred in less than 1% of procedures and there were no deaths.
authors.affiliation: Interventional Endoscopy Fellow, Gastroenterology and Hepatology Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, QLD 4102, Australia. alexhuelsen@yahoo.com.
authors.forename: Alexander
authors.initials: A
authors.lastname: Huelsen
authors.forename: Ramadan
authors.initials: R
authors.lastname: Oumer
authors.forename: Anna
authors.initials: A
authors.lastname: Ashcroft
authors.forename: Ross H
authors.initials: RH
authors.lastname: Roberts
authors.forename: Grant N
authors.initials: GN
authors.lastname: Coulter
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Kelly
authors.forename: Murray L
authors.initials: ML
authors.lastname: Barclay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004106:Dilatation / Q000379:methods; D004931:Esophageal Achalasia / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult