Tu1248 Achalasia Treatment With Pneumatic Balloon Dilation (PBD) Versus Laparoscopic Heller Myotomy (LHM). Systematic Review and Meta-Analysis

2017 ◽  
Vol 85 (5) ◽  
pp. AB600
Author(s):  
Priscilla C. Bonifacio ◽  
Nadia Korkischko ◽  
Marina L. Passos ◽  
Mileine V. de Matos ◽  
Julio Cesar M. Aquino ◽  
...  
Keyword(s):  
Systematic Review ◽  
Heller Myotomy ◽  
Meta Analysis ◽  
Balloon Dilation ◽  
Laparoscopic Heller Myotomy ◽  
Pneumatic Balloon Dilation

scholarly journals PERORAL (POEM) OR SURGICAL MYOTOMY FOR THE TREATMENT OF ACHALASIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 57 (1) ◽  
pp. 79-86 ◽  
Author(s):  
Rafael Krieger MARTINS ◽  
Igor Braga RIBEIRO ◽  
Diogo Turiani Hourneaux DE MOURA ◽  
Kelly E HATHORN ◽  
Wanderley Marques BERNARDO ◽  
...  
Keyword(s):  
Systematic Review ◽  
Gastroesophageal Reflux ◽  
Adverse Events ◽  
Heller Myotomy ◽  
Operative Time ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Laparoscopic Heller Myotomy ◽  
Eckardt Score ◽  
Post Procedure

ABSTRACT BACKGROUND: Achalasia is a neurodegenerative motility esophageal disorder characterized by failure of lower esophageal sphincter relaxation. The conventional treatment option for achalasia has been laparoscopic Heller myotomy (LHM). However, in 2010, Inoue et al. described peroral endoscopic myotomy (POEM), a minimally invasive procedure, as an alternative therapy. To date, some studies with small sample sizes have aimed to compare outcomes of LHM vs POEM. OBJECTIVE: Thus, the aim of this study is to perform a systematic review and meta-analysis to better evaluate the efficacy and safety of these two techniques. METHODS: Individualized search strategies were developed from inception through April 2019 in accordance with PRISMA guidelines. Variables analyzed included operative time, overall adverse events rate, post-procedure gastroesophageal reflux disease (GERD), hospitalization length, post-procedure pain score, and Eckardt Score reduction. RESULTS: Twelve cohort trials were selected, consisting of 893 patients (359 in POEM group and 534 in LHM.) No randomized clinical trials were available. There was no difference in operative time (MD= -10,26, 95% CI (-5,6 to 8,2), P<0.001) or Post-Operative Gastroesophageal Reflux (RD: -0.00, 95%CI: (-0.09, 0.09), I2: 0%). There was decreased length of hospital stay for POEM (MD: -0.6, 95% CI (-1.11, -0.09), P=0.02), and an increased mean reduction in Eckardt score in POEM patients (MD = -0.257, 95% CI: (-0.512 to -0.002), P=0.048), with similar rates of adverse events. CONCLUSION: POEM demonstrated similar results compared to laparoscopic Heller myotomy with regards to improvement of dysphagia, post-procedure reflux, and surgical time, with the benefit of shorter length of hospital stay. Therefore, POEM can be considered an option for patients with achalasia.

scholarly journals Diagnosis and Management of Achalasia: Updates of the Last Two Years

2021 ◽  
Vol 10 (16) ◽  
pp. 3607
Author(s):  
Amir Mari ◽  
Fadi Abu Baker ◽  
Rinaldo Pellicano ◽  
Tawfik Khoury
Keyword(s):  
Heller Myotomy ◽  
Neurodegenerative Disorder ◽  
Balloon Dilation ◽  
Therapeutic Endoscopy ◽  
Laparoscopic Heller Myotomy ◽  
Clinical Approach ◽  
High Resolution Manometry ◽  
Pneumatic Balloon Dilation ◽  
Endoscopic Myotomy ◽  
Per Oral

Achalasia is a rare neurodegenerative disorder causing dysphagia and is characterized by abnormal esophageal motor function as well as the loss of lower esophageal sphincter (LES) relaxation. The assessment and management of achalasia has significantly progressed in recent years due to the advances in high-resolution manometry (HRM) technology along with the improvements and innovations of therapeutic endoscopy procedures. The recent evolution of HRM technology with the inclusion of an adjunctive test, fluoroscopy, and EndoFLIP has enabled more precise diagnoses of achalasia to be made and the subgrouping into therapeutically meaningful subtypes. Current management possibilities include endoscopic treatments such as Botulinum toxin injected to the LES and pneumatic balloon dilation. Surgical treatment includes laparoscopic Heller myotomy and esophagectomy. Furthermore, in recent years, per oral endoscopic myotomy (POEM) has established itself as a principal endoscopic therapeutic alternative to the traditional laparoscopic Heller myotomy. The latest randomized trials report that POEM, pneumatic balloon dilatation, and laparoscopic Heller’s myotomy have comparable effectiveness and complications rates. The aim of the current review is to provide a practical clinical approach to dysphagia and to shed light on the most recent improvements in diagnostics and treatment of achalasia over the last two years.

ID: 3522484 LONG-TERM OUTCOMES OF PER ORAL ENDOSCOPIC MYOTOMY VERSUS LAPAROSCOPIC HELLER MYOTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 93 (6) ◽  
pp. AB300-AB301
Author(s):  
Ahmed Eltelbany ◽  
Abdul Mohammed ◽  
Sushrut Trakroo ◽  
George Khoudari ◽  
Osama Hamid ◽  
...  
Keyword(s):  
Systematic Review ◽  
Heller Myotomy ◽  
Meta Analysis ◽  
Laparoscopic Heller Myotomy ◽  
Long Term Outcomes ◽  
Per Oral Endoscopic Myotomy ◽  
Endoscopic Myotomy ◽  
Per Oral

scholarly journals Diagnostics and Minimally Invasive Surgery for Achalasia Cardia

2018 ◽  
Vol 25 (4) ◽  
Author(s):  
Vadim Ratchik ◽  
Oleksandr Babii ◽  
Natalia Prolom ◽  
Boris Shevchenko
Keyword(s):  
Heller Myotomy ◽  
Disease Duration ◽  
Balloon Dilation ◽  
Laparoscopic Heller Myotomy ◽  
Group Iv ◽  
Pneumatic Dilation ◽  
Achalasia Cardia ◽  
Group Iii ◽  
Group I ◽  
Pneumatic Balloon Dilation

The objective of the research was to assess the effectiveness of balloon pneumatic dilation and laparoscopic Heller myotomy in treatment of patients with achalasia cardia. Materials and methods. Twenty-one patients with achalasia cardia were examined and treated using pneumatic balloon dilation and laparoscopic Heller myotomy in the Department of Surgery from January 2016 to April 2018. There were 8 (38.1%) men and 13 (61.9%) women at the age of 28 to 75 years (the average age was (51.47 ± 3.63) years) and disease duration of 1 month to 8 years (the average disease duration was (3.05 ± 0.49) years).             Results and discussion. With the help of radiological methods of examination, all the patients were divided into 4 groups according to the esophageal diameter: Group I included 5 (23.8%) patients with the esophagus up to 4-5 cm in diameter; Group II comprised 6 (28.6%) patients with the esophagus up to 4-6 cm in diameter; Group III included 5 (23.8%) patients with the esophagus up to 6-8 cm in diameter; Group IV consisted of 5 (23.8%) patients with the esophagus of more than 8 cm in diameter and an S-shaped configuration. A significant decrease in the diameter of the esophagus according to fluoroscopy (p<0.05) alongside with a decrease in the lower esophageal sphincter pressure according to manometry are indicative in assessing the effectiveness of achalasia cardia treatment after minimally invasive surgery. There were no complications when performing pneumatic balloon dilation and laparoscopic Heller myotomy.             Conclusions. In 7 (33.3%) patients, recurrences of achalasia cardia after balloon pneumatic dilation occurred within 2 - 10 months: in 4.7% of patients in Group I and 9.5% of patients in Group II, Group III, and Group IV. In recurrent achalasia cardia, repeated dilation was ineffective. There was performed laparoscopic Heller myotomy with Dor fundoplication, which was effective in 80.0% of cases.

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