Health economic evaluation of therapeutic strategies in patients with idiopathic achalasia: results of a randomized trial comparing pneumatic dilatation with laparoscopic cardiomyotomy

Kostic, Srdjan; Johnsson, Erik L.; Kjellin, Ann; Ruth, Magnus; Lönroth, Hans; Andersson, Mats; Lundell, Lars

doi:10.1007/s00464-007-9310-0

Cited by 40 publications

(23 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…By contrast, pneumatic dilation, botulinum toxin injection, and pharmacological treatment are temporary and reversible measures. Moreover, Kostic et al [24] showed that initial treatment cost and total costs were significantly higher for laparoscopic myotomy compared with a pneumatic dilatation-based strategy (P = 0.0002 and P = 0.0019, respectively). However, the cost-effectiveness analysis, relating to the actual treatment failures, revealed that the cost-effectiveness of pneumatic dilatation is superior, at least when a reasonable time horizon is applied.…”

Section: Discussionmentioning

confidence: 96%

See 1 more Smart Citation

Meta-Analysis of Randomized and Controlled Treatment Trials for Achalasia

Wang

2008

Dig Dis Sci

131

View full text Add to dashboard Cite

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. We searched electronic databases (MEDLINE, EMBASE, Cochrane Central Registry of Controlled Trials, LILACS-Latin American, Caribbean health science literature, and Science Citation Index Expanded) for randomized controlled trials to evaluate 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. Seventeen studies with 761 patients met our inclusion criteria. There was better remission rate in pneumatic dilation than in botulinum toxin injection for initial intervention [relative risk (RR) 2.20, 95% confidence interval (CI) 1.51-3.20], Pneumatic dilation had lower relapse rate than did botulinum toxin injection (RR 0.12, 95% CI 0.04-0.32). Compared with pneumatic dilation, laparoscopic myotomy further increased remission rate (RR 1.48, 95% CI 1.48-1.87), and reduced clinical relapse rate (RR 0.14, 95% CI 0.04-0.58), and there was no difference in complication rate (RR 1.48, 95% CI 0.37-5.99). 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.

show abstract

Section: Discussionmentioning

confidence: 96%

“…Two randomized studies [23,24] compared the efficacy of pneumatic dilation with laparoscopic myotomy in patients with achalasia. Our meta-analysis showed that there were We used the Jadad scale to assess the quality of trial.…”

Section: Pneumatic Dilation Versus Laparoscopic Myotomymentioning

confidence: 99%

Meta-Analysis of Randomized and Controlled Treatment Trials for Achalasia

Wang

2008

Dig Dis Sci

131

View full text Add to dashboard Cite

show abstract

“…Few studies have compared pneumatic dilation (PD) with surgical myotomy, most of them retrospectively and with different techniques (different types of balloons and open vs. laparoscopic myotomy). Some studies have found similar results between both forms of treatment while others have found better results with surgical myotomy in the short and long term …”

Section: Introduction and Aimsmentioning

confidence: 89%

Pneumatic dilation versus laparoscopic Heller myotomy for the treatment of achalasia: variables related to a good response

et al. 2013

View full text Add to dashboard Cite

Achalasia is a motor disorder characterized by esophageal aperistalsis and failure of lower esophageal sphincter relaxation. The cardinal symptoms are dysphagia, food regurgitation and weight loss. The most effective treatments are pneumatic dilation (PD) of the cardia and Heller esophageal myotomy with partial fundoplication. There is still controversy regarding which treatments should be initially done. The aims of this study were to evaluate clinical response and the variables related to good results in both treatments. Ninety-two patients with achalasia diagnosed by esophageal manometry were randomized to receive either PD or laparoscopic Heller myotomy with partial fundoplication. After the procedure, patients were followed up clinically and submitted to esophageal manometry and pH monitoring. Three months after treatment, 73% of the patients from PD group and 84% of the surgery group had good results (P = 0.19). After 2 years of follow-up, 54% of the PD group and 60% of the surgery group (P = not significant) were symptom free. Variables related to a good response to PD were a 50% drop in lower esophageal sphincter pressure (LESP) or a LESP <10 mmHg after treatment. Patients over 40 years old with LESP ≤32 mmHg before treatment and a drop in LESP >50% after treatment significantly achieved better responses after surgical treatment when compared with PD. The reflux rate was significantly higher in the PD group (27.7%) compared with the surgery group (4.7%), P = 0.003. We concluded that surgical treatment and PD for achalasia are equally effective even after 2 years of follow-up. The choice of treatment for achalasia should be based on the following parameters: treatment availability, rate of good results, complication rates, variables related to good responses and also the patient's wish.

show abstract

“…Median total direct medical costs of achalasia patients were €2283 in the first year after diagnosis. Previously, costs for pneumatic dilatation and Heller myotomy have been estimated to be approximately €2000 and €7000 respectively . The European Achalasia trial calculated total costs of €3259 for PD and €6720 for Heller .…”

Section: Discussionmentioning

confidence: 99%