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Updated: Sep 4, 2025
Author Spotlight: Cutting-Edge Robotic Heller Myotomy Protocol for Treatment of Achalasia
Published on: February 16, 2024
Comparison of Endoscopic Dilatation and Heller's Myotomy for Treating Esophageal Achalasia in Children: A Multicenter
Audrey Nicolas1, Madeleine Aumar2, Léa Chantal Tran3
1Department of Pediatrics, CHU Limoges, Limoges, France; Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University Lille, Lille, France.
Insights
Heller's myotomy is more effective than endoscopic dilatation for treating achalasia in children. Both treatments have similar complication rates, but Heller's myotomy offers longer-lasting results.
Area of Science:
- Pediatric Gastroenterology
- Surgical Innovation
- Esophageal Motility Disorders
Background:
- Achalasia is a rare esophageal motility disorder affecting children.
- Current treatment options include endoscopic dilatation and surgical cardiomyotomy (Heller's myotomy).
- Comparing the long-term efficacy and safety of these treatments is crucial for pediatric care.
Purpose of the Study:
- To compare the efficacy and complication rates of Heller's myotomy versus endoscopic dilatation in pediatric achalasia.
- To evaluate treatment success defined by clinical improvement and absence of further interventions.
- To analyze the long-term outcomes of different achalasia treatment modalities.
Main Methods:
- Retrospective data collection from 8 tertiary pediatric centers over 11 years.
- Inclusion of 97 children diagnosed with achalasia.
- Definition of treatment success as clinical improvement without need for new treatment within 3 months.
Main Results:
- Heller's myotomy demonstrated significantly higher success rates compared to endoscopic dilatation (HR 3.93, P=.001).
- Median survival without treatment failure was 49 months for Heller's myotomy versus 7 months for dilatation.
- No significant difference in complication rates was observed between the two treatment groups (35.2% vs 29.7%).
Conclusions:
- Heller's myotomy is a more successful primary treatment for pediatric achalasia than endoscopic dilatation.
- Both treatments exhibit comparable safety profiles regarding serious complications.
- Peroral endoscopic myotomy (POEM) presents a potential alternative to Heller's myotomy, warranting further investigation.
Objective:
To compare the efficacy of, and complications from, the 2 main treatments for achalasia: endoscopic dilatation and surgical cardiomyotomy (Heller's myotomy).
Study Design:
We retrospectively collected data on children treated for achalasia over an 11-year period from 8 tertiary pediatric centers. A line of treatment was defined as performing either Heller's myotomy or 1-3 sessions of endoscopy dilatation over 3 months. Treatment success was a priori defined as clinical improvement and no need for new treatment.
Results:
Ninety-seven children (median age, 12 years; 57% boys) were included. The median time to diagnosis was 10.5 months, and the median follow-up period was 27 months. Thirty-seven children were treated by Heller's myotomy and 60 by endoscopy dilatation as the first-line treatment. After adjustment for potentially confounding factors, Heller's myotomy was significantly more successful than endoscopy dilatation (hazard ratio, 3.93 [1.74; 8.88]; P = .001), with a median survival without failure of 49 and 7 months, respectively, and with no significant difference in the occurrence of complications (35.2% for Heller's myotomy, 29.7% for endoscopy dilatation, P = .56). Hydrostatic dilatation was as successful as pneumatic dilatation (hazard ratio, 1.35 [0.56; 3.23]; P = .50).
Conclusions:
Heller's myotomy is more successful than endoscopy dilatation, with no significant difference in the occurrence of serious complications. This raises the potential role of peroral endoscopic myotomy as an alternative treatment to Heller's myotomy.
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