Efficacy and Safety of Laparoscopic Heller's Myotomy in the Treatment of Achalasia: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 WEINing ¹ , HUWen-teng ¹ , CAIan-qian ² , LINRui-jiang ¹ , ZHANGYu ¹ , MAMin-jie ¹ ,  HANBiao ¹

1. Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, China;
2. Department of Cardiac Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, China;

Corresponding author：

HANBiao, Email: hanbiao66@msn.com

Keywords：

Achalasia; Laparoscopic Heller's myotomy; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20160088

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Objective To systematically review the efficacy and safety of laparoscopic Heller's myotomy (LHM) versus pneumatic dilatation (PD) for achalasia. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 8, 2015), Web of Knowledge, CNKI, CBM, WanFang Data and VIP were searched from inception to August 26th 2015, to collect randomized controlled trials (RCTs) of LHM versus PD for achalasia. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results A total of 5 RCTs involving 446 patients were included. The results of meta-analysis showed that, compared with PD, LHM could significantly improve the effective rates after 3-month and 1-year follow-up (OR=2.66, 95%CI 1.08 to 6.60, P=0.03; OR=2.24, 95%CI 1.29 to 3.87, P=0.004). There were no statistical differences between the two groups in effective rate after more than 2-year follow-up (OR=1.749, 95%CI 0.99 to 3.23, P=0.05) and incidence of complications (OR=0.27, 95%CI 0.06 to 1.13, P=0.07). Conclusion Current evidence shows that, compared with PD, LHM could improve the short-term effective rate but could not improve the long-term (2-3 years) effective rate and reduce the incidence of complications. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

Citation： WEINing, HUWen-teng, CAIan-qian, LINRui-jiang, ZHANGYu, MAMin-jie, HANBiao. Efficacy and Safety of Laparoscopic Heller's Myotomy in the Treatment of Achalasia: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(5): 573-578. doi: 10.7507/1672-2531.20160088 Copy

1.	Farrukh A, Mayberry JF. Achalasia: an epidemiology update. Esophagus, 2015, 12(2): 170-174.
2.	Boeckxstaens GE, Zaninotto G, Richter JE. Achalasia. Lancet, 2014, 383(9911): 83-93.
3.	Podas T, Eaden J, Mayberry M, et al. Achalasia: a critical review of epidemiological studies. Am J Gastroenterol, 1998, 93(12): 2345-2347.
4.	Kraichely RE, Farrugia G. Achalasia: physiology and etiopathogenesis. Dis Esophagus, 2006, 19(4): 213-223.
5.	Zendehdel K, Nyrén O, Edberg A, et al. Risk of esophageal adenocarcinoma in achalasia patients, a retrospective cohort study in Sweden. Am J Gastroenterol, 2011, 106(1): 57-61.
6.	Schoenberg MB, Vassiliou MC, Von Renteln D. Achalasia: advances in treatment. Expert Rev Gastroenterol Hepatol, 2014, 8(7): 767-773.
7.	Smeets FG, Masclee AA, Keszthelyi D, et al. Esophagogastric junction distensibility in the management of achalasia patients: relation to treatment outcome. Neurogastroenterol Motil, 2015, 27(10): 1495-1503.
8.	Urbach DR, Hansen PD, Khajanchee YS, et al. A decision analysis of the optimal initial approach to achalasia: laparoscopic Heller myotomy with partial fundoplication, thoracoscopic Heller myotomy, pneumatic dilatation, or botulinum toxin injection. J Gastrointest Surg, 2001, 5(2): 192-205.
9.	Kostic S, Johnsson E, Kjellin A, et al. Health economic evaluation of therapeutic strategies in patients with idiopathic achalasia: results of a randomized trial comparing pneumatic dilatation with laparoscopic cardiomyotomy. Surg Endosc, 2007, 21(7): 1184-1189.
10.	Karanicolas PJ, Smith SE, Inculet RI, et al. The cost of laparoscopic myotomy versus pneumatic dilatation for esophageal achalasia. Surg Endosc, 2007, 21(7): 1198-1206.
11.	Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
12.	Persson J, Johnsson E, Kostic S, et al. Treatment of achalasia with laparoscopic myotomy or pneumatic dilatation: long-term results of a prospective, randomized study. World J Surg, 2015, 39(3): 713-720.
13.	Hamdy E, El Nakeeb A, El Hanfy E, et al. Comparative Study Between Laparoscopic Heller Myotomy Versus Pneumatic Dilatation for Treatment of Early Achalasia: A Prospective Randomized Study. J Laparoendosc Adv Surg Tech A, 2015, 25(6): 460-464.
14.	Borges AA, Lemme EM, Abrahao LJ Jr, et al. Pneumatic dilation versus laparoscopic Heller myotomy for the treatment of achalasia: variables related to a good response. Dis Esophagus, 2014, 27(1): 18-23.
15.	Boeckxstaens GE, Annese V, des Varannes SB, et al. Pneumatic dilation versus laparoscopic Heller's myotomy for idiopathic achalasia. N Engl J Med, 2011, 364(19): 1807-1816.
16.	Kostic S, Kjellin A, Ruth M, et al. Pneumatic dilatation or laparoscopic cardiomyotomy in the management of newly diagnosed idiopathic achalasia. World J Surg, 2007, 31(3): 470-478.
17.	Stewart KC, Finley RJ, Clifton JC, et al. Thoracoscopic versus laparoscopic modified Heller myotomy for achalasia: efficacy and safety in 87 patients. J Am Coll Surg, 1999, 189(2): 164-169.
18.	Wu JC. Pneumatic Dilation versus Laparoscopic Heller's Myotomy for Idiopathic Achalasia (N Engl J Med 2011; 364: 1807-1816). J Neurogastroenterol Motil, 2011, 17(3): 324-326.
19.	Moonen A, Annese V, Bredenoord AJ, et al. Mo1874 Long-Term Results of the European Achalasia Trial: Pneumatic Dilation versus Laparoscopic Heller Myotomy. Gastroenterology, 2014, 146(5): S-678.
20.	Rohof WO, Salvador R, Annese V, et al. Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterology, 2013, 144(4): 718-725.
21.	Hoppo T, Jobe BA. Is laparoscopic Heller myotomy superior to pneumatic dilation to treat achalasia? Semin Thorac Cardiovasc Surg, 2011, 23(3): 178-180.
22.	Yaghoobi M, Mayrand S, Martel M, et al. Laparoscopic Heller's myotomy versus pneumatic dilation in the treatment of idiopathic achalasia: a meta-analysis of randomized, controlled trials. Gastrointest Endosc, 2013, 78(3): 468-475.

1. Farrukh A, Mayberry JF. Achalasia: an epidemiology update. Esophagus, 2015, 12(2): 170-174.
2. Boeckxstaens GE, Zaninotto G, Richter JE. Achalasia. Lancet, 2014, 383(9911): 83-93.
3. Podas T, Eaden J, Mayberry M, et al. Achalasia: a critical review of epidemiological studies. Am J Gastroenterol, 1998, 93(12): 2345-2347.
4. Kraichely RE, Farrugia G. Achalasia: physiology and etiopathogenesis. Dis Esophagus, 2006, 19(4): 213-223.
5. Zendehdel K, Nyrén O, Edberg A, et al. Risk of esophageal adenocarcinoma in achalasia patients, a retrospective cohort study in Sweden. Am J Gastroenterol, 2011, 106(1): 57-61.
6. Schoenberg MB, Vassiliou MC, Von Renteln D. Achalasia: advances in treatment. Expert Rev Gastroenterol Hepatol, 2014, 8(7): 767-773.
7. Smeets FG, Masclee AA, Keszthelyi D, et al. Esophagogastric junction distensibility in the management of achalasia patients: relation to treatment outcome. Neurogastroenterol Motil, 2015, 27(10): 1495-1503.
8. Urbach DR, Hansen PD, Khajanchee YS, et al. A decision analysis of the optimal initial approach to achalasia: laparoscopic Heller myotomy with partial fundoplication, thoracoscopic Heller myotomy, pneumatic dilatation, or botulinum toxin injection. J Gastrointest Surg, 2001, 5(2): 192-205.
9. Kostic S, Johnsson E, Kjellin A, et al. Health economic evaluation of therapeutic strategies in patients with idiopathic achalasia: results of a randomized trial comparing pneumatic dilatation with laparoscopic cardiomyotomy. Surg Endosc, 2007, 21(7): 1184-1189.
10. Karanicolas PJ, Smith SE, Inculet RI, et al. The cost of laparoscopic myotomy versus pneumatic dilatation for esophageal achalasia. Surg Endosc, 2007, 21(7): 1198-1206.
11. Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
12. Persson J, Johnsson E, Kostic S, et al. Treatment of achalasia with laparoscopic myotomy or pneumatic dilatation: long-term results of a prospective, randomized study. World J Surg, 2015, 39(3): 713-720.
13. Hamdy E, El Nakeeb A, El Hanfy E, et al. Comparative Study Between Laparoscopic Heller Myotomy Versus Pneumatic Dilatation for Treatment of Early Achalasia: A Prospective Randomized Study. J Laparoendosc Adv Surg Tech A, 2015, 25(6): 460-464.
14. Borges AA, Lemme EM, Abrahao LJ Jr, et al. Pneumatic dilation versus laparoscopic Heller myotomy for the treatment of achalasia: variables related to a good response. Dis Esophagus, 2014, 27(1): 18-23.
15. Boeckxstaens GE, Annese V, des Varannes SB, et al. Pneumatic dilation versus laparoscopic Heller's myotomy for idiopathic achalasia. N Engl J Med, 2011, 364(19): 1807-1816.
16. Kostic S, Kjellin A, Ruth M, et al. Pneumatic dilatation or laparoscopic cardiomyotomy in the management of newly diagnosed idiopathic achalasia. World J Surg, 2007, 31(3): 470-478.
17. Stewart KC, Finley RJ, Clifton JC, et al. Thoracoscopic versus laparoscopic modified Heller myotomy for achalasia: efficacy and safety in 87 patients. J Am Coll Surg, 1999, 189(2): 164-169.
18. Wu JC. Pneumatic Dilation versus Laparoscopic Heller's Myotomy for Idiopathic Achalasia (N Engl J Med 2011; 364: 1807-1816). J Neurogastroenterol Motil, 2011, 17(3): 324-326.
19. Moonen A, Annese V, Bredenoord AJ, et al. Mo1874 Long-Term Results of the European Achalasia Trial: Pneumatic Dilation versus Laparoscopic Heller Myotomy. Gastroenterology, 2014, 146(5): S-678.
20. Rohof WO, Salvador R, Annese V, et al. Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterology, 2013, 144(4): 718-725.
21. Hoppo T, Jobe BA. Is laparoscopic Heller myotomy superior to pneumatic dilation to treat achalasia? Semin Thorac Cardiovasc Surg, 2011, 23(3): 178-180.
22. Yaghoobi M, Mayrand S, Martel M, et al. Laparoscopic Heller's myotomy versus pneumatic dilation in the treatment of idiopathic achalasia: a meta-analysis of randomized, controlled trials. Gastrointest Endosc, 2013, 78(3): 468-475.

Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of Laparoscopic Heller's Myotomy in the Treatment of Achalasia: A Meta-analysis

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