Is Heller myotomy better than balloon dilation? A meta-analysis

Area of Science:

• Gastroenterology
• Surgical Endoscopy
• Comparative Effectiveness Research

Background:

• Achalasia is a primary esophageal motility disorder.
• Endoscopic balloon dilation (EBD) and laparoscopic Heller myotomy (LHM) are leading treatments.
• Choosing between EBD and LHM can be challenging for clinicians.

Purpose of the Study:

• To conduct a meta-analysis comparing the efficacy and safety of EBD versus LHM for achalasia.
• To provide evidence-based guidance for treatment selection in achalasia patients.

Main Methods:

• Systematic literature search of PubMed, Embase, and Cochrane databases (1976-2015).
• Meta-analysis using PICOS framework to compare EBD and LHM.
• Forest plot analysis of success rates, perforation, and gastroesophageal reflux.

Main Results:

• Eight studies with 749 patients (360 EBD, 389 LHM) were included.
• LHM demonstrated a significantly higher success rate than EBD (OR=0.486, p=0.003).
• No significant differences were found in perforation rates (p=0.154) or symptomatic reflux (p=0.254) between EBD and LHM.

Conclusions:

• Laparoscopic Heller myotomy (LHM) is more efficacious than endoscopic balloon dilation (EBD) for achalasia.
• Both EBD and LHM exhibit comparable safety profiles.
• LHM offers superior treatment outcomes for achalasia patients.