Although rare, esophageal achalasia is the best described primary esophageal motility disorder.
Commonly used treatments are endoscopic botulin toxin injection, endoscopic balloon dilation, and surgical myotomy with or without a fundoplication.
However, reported outcomes mostly come from cohort studies.
Dr Guilherme Campos and colleagues summarized and compared the safety and efficacy of endoscopic and surgical treatments for esophageal achalasia.
The team performed a systematic electronic Medline literature search of articles on esophageal achalasia.
Treatment options reviewed included endoscopic botulin toxin injection, endoscopic balloon dilation, and surgical myotomy using open and minimally invasive techniques.
Main outcome measures were frequency of symptom relief, prevalence of post-treatment gastroesophageal reflux, and complications.
|The need for additional therapy was greater with endoscopic botulin toxin injection|
|Annals of Surgery
Outcome probability was estimated using weighted averages of the sample prevalence in each study, with weights equal to the number of patients.
Outcomes, within or across studies, were compared using meta-analysis and meta-regression, respectively.
The researchers selected a total of 105 articles reporting on 7855 patients.
Symptom relief after endoscopic balloon dilation was better than after endoscopic botulin toxin injection.
The team noted that the need for additional therapy was greater for patients receiving endoscopic botulin toxin injection.
Laparoscopic myotomy, when combined with an antireflux procedure, provided better symptom relief than all endoscopic and other surgical approaches and a low complication rate.
The incidence of postoperative gastroesophageal reflux was lower when a fundoplication was added to a laparoscopic myotomy.
Dr Campos‘ team concluded, “Endoscopic balloon dilation is superior to endoscopic botulin toxin injection.”
“Laparoscopic myotomy with fundoplication was the most effective surgical technique and can be considered the operative procedure of choice.”