Evaluating surgical management of primary achalasia-a systematic review and network meta-analysis of randomized clinical trials.
John P Morrison, Matthew G Davey, Noel E Donlon
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In 30 seconds
This systematic review and network meta-analysis evaluated the outcomes of various surgical interventions for primary achalasia in 1170 patients across 15 randomized clinical trials. The study found that Heller's myotomy and peroral endoscopic myotomy (POEM) had significantly higher treatment success rates at 5 years compared to botulinum toxin injections, with odds ratios of 6.39 and 6.33, respectively.
Key findings
- Botulinum toxin injections had significantly lower treatment success at 1 year (OR, 0.10; 95% CI, 0.01-0.89).
- Heller's myotomy showed significantly greater treatment success at 5 years (OR, 6.39; 95% CI, 1.24-32.89).
- POEM also demonstrated significant treatment success at 5 years (OR, 6.33; 95% CI, 2.83-14.0).
- Pneumatic dilatation resulted in a significantly higher lower esophageal sphincter pressure (mean difference, 4.72; 95% CI, 1.13-8.31).
Why it matters
Understanding the comparative effectiveness of surgical options for achalasia is crucial for optimizing patient outcomes. This analysis provides evidence to guide treatment decisions, emphasizing the importance of individualized approaches based on patient characteristics and available expertise.