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Updated: Jan 4, 2026
Author Spotlight: Cutting-Edge Robotic Heller Myotomy Protocol for Treatment of Achalasia
Published on: February 16, 2024
Heller myotomy versus endoscopic balloon dilatation for achalasia: A single center experience
Felix Nickel1, Philip C Müller1, Javier R de la Garza1
1Department of General, Visceral and Transplant Surgery.
Insights
Laparoscopic Heller myotomy (LHM) and endoscopic balloon dilatation (EBD) offer similar symptom relief for achalasia. However, LHM provides more sustained treatment with a lower reintervention rate compared to EBD.
Area of Science:
- Gastroenterology
- Surgical Procedures
- Medical Device Technology
Background:
- Achalasia is a rare esophageal motility disorder.
- Laparoscopic Heller myotomy (LHM) and endoscopic balloon dilatation (EBD) are primary treatment options.
- Comparing long-term outcomes is crucial for patient management.
Purpose of the Study:
- To compare clinical outcomes of LHM versus EBD for achalasia.
- To assess symptom relief, quality of life (QoL), and patient satisfaction.
- To evaluate the long-term efficacy and reintervention rates of both procedures.
Main Methods:
- Retrospective chart review and prospective follow-up of 36 achalasia patients (19 LHM, 17 EBD).
- Assessment of perioperative data, therapeutic efficiency (Eckardt score), GI Quality of Life Index (GIQLI), and patient satisfaction.
- Mean follow-up duration of approximately 77 months for both groups.
Main Results:
- No significant differences in Eckardt score, GIQLI, or patient satisfaction between LHM and EBD groups.
- Higher reintervention rate observed in the EBD group (100% required multiple dilatations) compared to LHM (10.5% required dilatation).
- LHM demonstrated a more sustained treatment effect despite similar initial outcomes.
Conclusions:
- Both LHM and EBD effectively manage achalasia symptoms, improving QoL and patient satisfaction.
- LHM offers a more durable solution due to a significantly lower need for reintervention.
- EBD, while safe and effective for symptom control, is associated with a higher reintervention frequency.
Abstract:
This study aimed to compare clinical results, symptom relief, quality of life and patient satisfaction after the 2 most common procedures for achalasia treatment: laparoscopic Heller myotomy (LHM) and endoscopic balloon dilatation (EBD).Patients treated at University Hospital of Heidelberg with LHM or EBD were included. A retrospective chart review of perioperative data and a prospective follow-up of therapeutic efficiency, Gastrointestinal Quality of Life Index (GIQLI) and patient satisfaction was conducted.Follow-up data (mean follow-up: 75.1 ± 53.9 months for LHM group and 78.9 ± 45.6 months for EBD) were obtained from 36 patients (19 LHM; 17 EBD). Eckardt score (median (q1,q3): 2 (1,4) in both groups, P = .91, GIQLI (LHM: 117 (91.5, 126) vs EBD: 120 (116, 128), P = .495) and patient satisfaction (3 (2,3) vs 3 (2,4), P = .883) did not differ between groups. Fifteen patients (78.9%) in LHM group and 11 (64.7%) in EBD group (P = .562) stated they would undergo the intervention again. All patients with EBD had at least 2 dilatations (100%), whilst only 2 patients (10.5%) had dilatation after LHM (P < .001). There were no complications after EBD, but 2 after LHM (10.5%, P = .517).Both LHM and EBD are able to control symptoms and provide similar quality of life and patient satisfaction. However, reintervention rate was higher following EBD, hence LHM provided a more sustained treatment than EBD.
