Pharmacological therapy, botulinum toxin injection, pneumatic dilatation, and surgical myotomy are the primary therapeutic modalities for achalasia, for which laparoscopic myotomy is recommended as state-of-the-art therapy. 

However, its efficacy and safety remain unclear compared with other approaches in the treatment of achalasia. 

Dr Lan Wang and colleagues from China searched electronic databases for randomized controlled trials.

The team evaluated which therapeutic measures are temporary and reversible, and which measures are definitive and effective by pooling data including remission rate, relapse rate, complications, and adverse effects. 

Pneumatic dilation had a lower relapse rate than botulinum toxin injection

Digestive Diseases and Sciences

The researchers identified 17 studies with 761 patients that met the inclusion criteria. 

The research team found there was better remission rate in pneumatic dilation than in botulinum toxin injection for initial intervention. 

Pneumatic dilation had a lower relapse rate than did botulinum toxin injection.

 

The team noted that laparoscopic myotomy further increased remission rate, and reduced clinical relapse rate with there was no difference in complication rate.

Dr Wang's team concluded, "Based on limited randomized and controlled trials, laparoscopic myotomy is the preferred method for patients with achalasia."

"Future trials should investigate whether laparoscopic myotomy combined with different modalities of fundoplication is superior to isolated laparoscopic myotomy."