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02.04.2024 | Systematic review with meta-analysis

Efficacy and safety of laparoscopic Heller’s myotomy versus pneumatic dilatation for achalasia: A systematic review and meta-analysis of randomized controlled trials

verfasst von: Adnan Malik, Shahbaz Qureshi, Abdul Nadir, Muhammad Imran Malik, Douglas G. Adler

Erschienen in: Indian Journal of Gastroenterology

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Abstract

Background and Objectives

Achalasia has several treatment modalities. We aim to compare the efficacy and safety of laparoscopic Heller myotomy (LHM) with those of pneumatic dilatation (PD) in adult patients suffering from achalasia.

Methods

We searched Cochrane CENTRAL, PubMed, Web of Science, SCOPUS and Embase for related clinical trials about patients suffering from achalasia. The quality appraisal and assessment of risk of bias were conducted with GRADE and Cochrane’s risk of bias tool, respectively. Homogeneous and heterogeneous data was analyzed under fixed and random-effects models, respectively.

Results

The pooled analysis of 10 studies showed that PD was associated with a higher rate of remission at three months, one year, three years and five years (RR = 1.25 [1.09, 1.42] (p = 0.001); RR = 1.13 [1.05, 1.20] (p = 0.0004); RR = 1.48 [1.19, 1.82] (p = 0.0003); RR = 1.49 [1.18, 1.89] (p = 0.001)), respectively. LHM was associated with lower number of cases suffering from adverse events, dysphagia and relapses (RR = 0.50 [0.25, 0.98] (p = 0.04); RR = 0.33 [0.16, 0.71] (p = 0.004); RR = 0.38 [0.15, 0.97] (p = 0.04)), respectively. There is no significant difference between both groups regarding the lower esophageal pressure, perforations, remission rate at two years, Eckardt score after one year and reflux.

Conclusion

PD had higher remission rates than LHM at three months, one year and three years, but not at two years or five years. More research is needed to determine whether PD has a significant advantage over LHM in terms of long-term remission rates.

Graphical abstract

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Titel: Efficacy and safety of laparoscopic Heller’s myotomy versus pneumatic dilatation for achalasia: A systematic review and meta-analysis of randomized controlled trials
verfasst von: Adnan Malik
Shahbaz Qureshi
Abdul Nadir
Muhammad Imran Malik
Douglas G. Adler
Publikationsdatum: 02.04.2024
Verlag: Springer India
Erschienen in: Indian Journal of Gastroenterology
Print ISSN: 0254-8860
Elektronische ISSN: 0975-0711
DOI: https://doi.org/10.1007/s12664-023-01497-8

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