Background Though nitrates have been used in achalasia for a long time, the effectiveness of nitrates for achalasia is still controversial. Objectives To quantify short-term and long-term effects of nitrate therapy in patients with achalasia. Search strategy Trials were identified by searching the Cochrane Controlled Trials Register (Issue 4, 2001), MEDLINE (1966-2001), EMBASE (1980-2001), LILACS-Latin American and Caribbean health science literature (1982-2001) and CBM-Chinese Biomedical Database (1980-2000). Additionally, all references in the identified trials were checked for further relevant trials. Selection criteria All randomised controlled trials involving achalasia patients given any type of nitrates were included. Data collection amp; analysis Data were extracted By two independent observers based on the intention-to-treat principle. Odds ratios for the patients need to treat by invasive procedures, improvement of symptoms, LES pressure decrease, oesophageal emptying, and side effects were calculated. Numbers needed to treat (NNT) for avoiding invasive procedure, improvement of symptoms, oesophageal emptying, and numbers needed to harm (NNH) of side effects were also determined. Main results Two randomised cross-over studies were found, But no results are included. Due to the design of the studies and the method of reporting the results in the original paper it was not possible to extract the necessary information to examine any of the outcomes. Authors have been contacted to obtain this information. Reviewers’ conclusion We can conclude no implications for practice at this stage. Much more RCT data are needed to determine the effects of nitrates.
Objective To review the clinical experience of Heller myotomy for treatment of achalasia through a small thoracotomy. Methods Twenty-five patients with achalasia (9 moderate, 16 severe) underwent Heller myotomy without concomitant antireflux procedure through a small incision. A left thoracotomy was carried out through either the seventh or eighth intercostals space. The length of skin incision was 6 to 8 cm. Results There was no hospital death and severe postoperative complications. The mean operating time was 50 minutes. Mean hospital stay was 10 days. There was one intraoperative perforation and repaired successfully. All patients reported good to excellent relief of dysphagia and no symptom of gastroesophageal reflux after surgery. Eight patients were subsequently studied with a 24-hour esophageal pH monitoring and no evidence of pathologic reflux found. Conclusions Transthoracic Heller myotomy with a small incision is effective and safe method for treatment of achalasia with minimal invasion, quick recovery, less postoperative complication and shorter hospital stay. Proper extent of the myotomy may decrease the risk of subsequent gastroesophageal reflux in the postoperative period.
Mini-invasive video-assisted thoracoscopic surgery (VATS) has been employed in diagnosis and treatment of esophageal diseases for about 10 years. The potential advantages of VATS over thoracotomy are reduction of chest pain just after the operation and in the long run, lower incidence of postoperative respiratory complications, and reduction of aesthetic sequelae. Thoracoscopic staging of esophageal cancer is to evaluate the invasion and metastasis of cancer, which is helpful for better selection of patients for appropriate treatment .Operation of esophageal cancer with VATS is prescribed mainly in the early stage of carcinoma, but it’s application is restricted due to the multiple sites of operation and complexity of procedures. VATS for benign esophageal diseases such as esophageal leiomyoma and achalasia is becoming the preferable choice of operation in qualified medical centers.
Objective Through the methods of evidence-based medicine, to make an individualized treatment plan for a patient with achalasia. Methods Based on an adequate assessment of the patient’s condition, clinical issues aimed at this case were put forward. And the best clinical evidence related to achalasia treatment was evaluated after being retrieved from The Cochrane library (1990 to 2010) and PubMed (1980 to 2010). Results 33 studies were retrieved including 29 RCTs and 4 systematic reviews. The efficacy and safety of drug therapy, endoscopic injection of botulinum, endoscopic balloon dilatation and surgical therapy were evaluated. Cosidering symptoms,age and comorbidities, we recommended endoscopic balloon dilatation or laparoscopic Heller postoperative plus Dor fundoplication surgery for treatment. The patient’s choice is endoscopic balloon dilatation. Symptoms of patient were relieved after treatment. Conclusion Making a rational therapeutic plan for achalasia patients by means of evidence-based treatment not only can improve therapeutic effect but also be beneficial for both doctors and patients to share uncertain risks.
Objective To determine the effectiveness and safety of pneumatic balloon dilatation in patients with achalasia. Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL, issue 1, 2007), MEDLINE or PUBMED (1978-2007), Embase (1978-2007), OVID Database (1978-2007), Chinese Biological Medicine Database (CBMDisc, 1978-2007), CNKI (1979-2007), Chinese VIP Database (1989-2007) and Wanfang Database (1978-2007). We also checked the reference lists of retrieved articles and relevant proceedings. We used the methods recommended by The Cochrane Collaboration to conduct this systematic review. Results Twenty four trials involving 1045 patients were included. Meta-analyses showed that the short-term total effective rate was much higher with pneumatic dilatation than intrasphincteric botulinum toxin injection (P=0.0007). The long-term total effective rate was higher with pneumatic dilatation compared to intrasphincteric botulinum toxin injection (P=0.005). Intrasphincteric botulinum toxin injection was superior to pneumatic dilatation in terms of clinical relapse rate (Plt;0.0001). Our analyses of complications and adverse effects found that pneumatic dilatation was superior to intrasphincteric botulinum toxin injection (P=0.0008), and endoscopic sphincterotomy was superior to balloon dilatation (P=0.0006). Conclusions The limited current evidence shows that: pneumatic dilatation is safe and effective for the short- or long-term treatment of achalasia.