Laparoscopic Heller myotomy most effective for treating achalasia
MedWire News: Laparoscopic Heller myotomy with fundoplication (LHM+Fp) has greater clinical success and results in less gastroesophageal reflux (GER) than pneumatic dilation (PD) for the treatment of achalasia, report Brazilian researchers.
Achalasia, characterized by difficulty swallowing and regurgitation, can be treated by PD or LHM surgery, but there is considerable debate about which technique gives the best outcome.
In this study, Paula Novais and Eponina Maria de Oliveira Lemme (Federal University of Rio de Janeiro) compared the two techniques for the treatment of achalasia in 94 patients with the condition, 47 of whom were treated with PD and 47 with LHM+Fp.
The patients were aged 49.4 years on average, and around 9.6% had achalasia due to Chagas disease. Nine patients were lost to follow-up, leaving 85 who underwent post-treatment assessment.
Resolution of achalasia after treatment occurred in 73.8% of the PD group and 88.3% of the LHM+Fp group, a borderline significant difference.
GER, a common side effect of achalasia treatment, occurred in 31.0% of the PD group, compared with just 4.7% of the LHM+Fp group, a significant difference.
Overall, hypotensive lower esophageal sphincter (more than a 50% drop in pressure) occurred in significantly more patients who underwent PD, at 35.7% versus 16.3% of those who underwent LHM+Fp.
Patients who presented with "true" GER, as confirmed by 24-hour pH monitoring, had a 53.3% incidence of hypotensive lower esophageal sphincter, whereas those with 24-hour pH results suggesting fermentation had an incidence of 28.6%.
"We believe the lowest complication rates should decide what treatment to choose," write the researchers in the journal Alimentary Pharmacology and Therapeutics.
"The higher incidence of true GER in the PD group suggests that surgery is a better therapeutic choice, as both are very effective," they suggest.
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By Helen Albert