In this study, researchers from Italy compared laparoscopic cardia myotomy and fundoplication with botulinum toxin (BoTx) injection in patients with esophageal achalasia.
The team randomly assigned 80 newly diagnosed achalasia patients to receive either BoTx injection or laparoscopic myotomy.
|Symptoms recurred in 65% of patients in the botulinium toxin group.
|Journal of Pediatrics|
Between 8 and 100 units of BoTx were injected twice, a month apart, at the esophagogastric junction. Myotomy included anterior partial (Dor) or Nissen fundoplication.
Patients' symptoms were scored, their lower esophageal sphincter resting and nadir pressures were measured by manometry. The team also used a barium swallow to assess esophageal diameter pre- and post-treatment.
There was no mortality.
The team found that 1 surgical patient bled from the trocar site.
They determined that the median hospital stay was 6 days for surgical patients, while BoTx patients were treated as day-hospital admissions.
All patients completed follow-up.
The researchers found that the results were similar between the 2 groups after 6 months. However, symptom scores improved more in surgical patients (82% versus 66%).
The drop in lower esophageal sphincter pressure was also similar between the 2 groups. However, the team found that the reduction in esophageal diameter was greatest in the surgical group (19% versus 5%).
The team found that symptoms recurred in 65% of patients in the BoTx group.
They calculated that the probability of being symptom free at 2 years was 88% for surgical patients and 34% for BoTx patients.
Dr Giovanni Zaninotto's team concluded, "Laparoscopic myotomy is as safe as BoTx treatment and is a 1-shot treatment that cures achalasia in most patients".
"BoTx should be reserved for patients who are unfit for surgery or as a bridge to more effective therapies, such as surgery or endoscopic dilation".