The cost of laparoscopic myotomy versus pneumatic dilatation for esophageal achalasia

Karanicolas, Paul J.; Smith, Shona E.; Inculet, Richard; Malthaner, Richard; Rеynolds, Robert; Goeree, Ron; Gafni, Amiram

doi:10.1007/s00464-007-9364-z

Cited by 36 publications

(20 citation statements)

References 56 publications

(31 reference statements)

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“…And they found that PD had a better 5-year efficacy than HM for patients aged > 40 years old (12). In addition, it has been demonstrated that the most cost-effective treatment for achalasia over a 5-10-year period after the procedure is PD (18,19). So, PD is recommended as an initial treatment for achalasia in elderly patients and theoretically leads to a favorable longterm outcome.…”

Section: Discussionmentioning

confidence: 99%

Peroral endoscopic myotomy versus pneumatic dilation for achalasia in patients aged = 65 years

Wang¹,

Tan²,

Lv³

et al. 2016

Rev Esp Enferm Dig

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Background and aim: Both peroral endoscopic myotomy (POEM) and pneumatic dilation (PD) has proved to be effective for treating achalasia in patients aged ≥ 65 years. However little is known about the comparison between POEM and PD. The aim of the study was to compare the safety and efficacy of POEM and PD for the treatment of achalasia in these patients.Methods: We retrospectively reviewed the medical records of patients aged 65 years-old or more who received POEM or PD for the treatment of achalasia at our hospital from January 2010 to December 2015, they were divided into the POEM group and the PD group. Demographics and data about safety and efficacy were collected retrospectively and compared between the two groups.Results: A total of 31 patients were enrolled, and 21 of them received POEM, while the other 10 received PD. The treatment success (Eckardt score ≤ 3) rate of POEM and PD at 3, 6, 12, 24 and 36 months after the treatment were comparable (p > 0.05). Treatment failure was noticed in 3 cases, 1 of them was in the POEM group and the other 2 in the PD group, there was no significant difference (p > 0.05). Multivariate analysis showed that sigmoid-type achalasia was a predictive factor of treatment failure. No severe complications were observed during operation and periodical follow-up.Conclusion: Short-term and intermediate efficacy of POEM and PD for treating achalasia in patients aged ≥ 65 years was comparable. A large scale, randomized study with long-term follow-up is necessary in order to make a definitive conclusion.

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Section: Discussionmentioning

confidence: 99%

Peroral endoscopic myotomy versus pneumatic dilation for achalasia in patients aged = 65 years

Wang¹,

Tan²,

Lv³

et al. 2016

Rev Esp Enferm Dig

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“…These are mainly young age (<40 years), male gender, single dilation with a 3.0 cm balloon, post-treatment LOS pressure >10–15 mm Hg and poor esophageal emptying on an upright barium oesophagram (timed barium swallow) 9 11 15–18. Pneumatic dilation is the most cost-effective treatment for achalasia over a time period of 5 to 10 years 19 20…”

Section: Pneumatic Dilationmentioning

confidence: 99%

Management of achalasia: surgery or pneumatic dilation

Richter

Boeckxstaens

2011

Gut

129

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Achalasia is an esophageal motility disorder of unknown cause, characterised by aperistalsis of the esophageal body and impaired lower esophageal sphincter relaxation. Patients present at all ages, primarily with dysphagia for solids/liquids and bland regurgitation. The diagnosis is suggested by barium esophagram or endoscopy and confirmed by esophageal manometry. Achalasia cannot be cured. Instead, our goal is to relieve symptoms, improve esophageal emptying and prevent the development of megaesophagus. The most successful therapies are pneumatic dilation and surgical myotomy. The advantages of pneumatic dilation include an outpatient procedure, minimal pain, return to work the next day, mild if any GERD, and can be performed in any age group and even during pregnancy. Pneumatic dilation does not hinder future myotomy, and all cost analyses find it less expensive than Heller myotomy. Laparoscopic myotomy with a partial fundoplication has the advantage of being a single procedure, dysphagia relief is longer at the cost of more troubling heartburn, and a myotomy may be more effective treatment in adolescents and younger adults, especially men. Over a two year horizon, the clinical success of pneumatic dilation and laparoscopic myotomy are comparable in a recent large European randomised trial. The prognosis for achalasia patients to return to near-normal swallowing and good quality of life are excellent, but few are "cured" with a single treatment and intermittent "touch up" procedures may be required.

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“…The major predictive factors for the failure of EBD treatment include young age (age < 40 years) [1,29], male gender, dilation by using a 30-mm balloon, presence of pulmonary symptoms, failure of treatment after one or two dilation sessions [27,30]. However, EBD is the most cost-effective treatment for achalasia for a period of 5 to 10 years after the procedures [13,31]. The most serious complication is perforation, which occurred in about 1-3% of the cases [5,11], and 50% of those patients required surgical intervention [12].…”

Section: Discussionmentioning

confidence: 99%

“…The most severe complication is perforation, which occurs in about 1-3% of the cases [5,11], 50% of cases requiring surgery [12]. Over a 5-10 year period the balloon dilation is the most cost-effective treatment for achalasia [13]. Decision between these treatment options is difficult to make due to the lack of large randomized controlled trials.…”

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confidence: 99%

Is Heller Myotomy Better than Balloon Dilation? A Meta-Analysis

Illés

Farkas

Hegyi³

et al. 2017

JGLD

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Background & Aim: Endoscopic balloon dilation (EBD) and laparoscopic Heller myotomy (LHM) are the most commonly performed treatment options for achalasia. Decision between these treatment options is difficult. The aim of this meta-analysis was to evaluate the efficacy of EBD compared to LHM.Methods: The electronic databases PubMed, Embase and Cochrane Controlled Trials Registry were systematically searched for the period between January 1, 1976 and December 31, 2015. Meta-analysis was performed using the PICOS (problem, intervention, comparison, outcome, study design) format. Efficacy and safety of EBD were compared to LHM. Forest plot analyses were used to illustrate the success rate, perforation rate and post-procedural gastroesophageal reflux.Results: Using the search strategy, eight studies met the selection criteria and were included in the meta-analysis. The total number of patients included was 749 (360 in the EBD group and 389 in the LHM group). The success rate was lower in the EBD group than in the LHM group (OR=0.486; CI: 0.304-0.779; p=0.003). The rate of perforation did not differ significantly between the EBD and LHM group (RR= 0.635, CI: 0.340-1.186, p=0.154). The incidence of post-procedural symptomatic gastroesophageal reflux did not differ between the two treatment groups (RR=0.663, CI: 0.328-1.343, p=0.254).Conclusion: Our data suggest that the efficacy of LHM is superior to that of EBD, while there is no difference in safety between the two treatment groups.Abbreviations: EBD: endoscopic balloon dilation; GERD: gastro-esophageal reflux disease; LES: lower esophageal sphincter; LHM: laparascopic Heller myotomy; OR: odds ratio; PICOS: Problem, Intervention, Comparison, Outcome, Study design; POEM: Per Oral Endoscopic Myotomy; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analysis; RR: risk ratio.

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The cost of laparoscopic myotomy versus pneumatic dilatation for esophageal achalasia

Cited by 36 publications

References 56 publications

Peroral endoscopic myotomy versus pneumatic dilation for achalasia in patients aged = 65 years

Peroral endoscopic myotomy versus pneumatic dilation for achalasia in patients aged = 65 years

Management of achalasia: surgery or pneumatic dilation

Is Heller Myotomy Better than Balloon Dilation? A Meta-Analysis

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