Related Experiment Video
Updated: Jun 14, 2026
Robotic Heller Myotomy for Advancements in Surgical Management of Achalasia
Published on: February 16, 2024
Pneumatic Balloon Dilation versus Heller's Myotomy in Pediatric Achalasia: A Systematic Review and Meta-Analysis
Marcella M Constante1, Kayla D Santos2, Letizia Corbi3
1Prefeitura Municipal de Contagem, Department of General Surgery, Minas Gerais, Brazil, Contagem.
Insights
Heller's myotomy (HM) reduces reoperation and symptom recurrence in pediatric achalasia compared to pneumatic balloon dilation (PBD). PBD is linked to lower gastroesophageal reflux disease (GERD) risk, but evidence is limited.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Outcomes Research
Background:
- Achalasia treatment in children lacks definitive comparative evidence.
- Pneumatic balloon dilation (PBD) and Heller's myotomy (HM) are primary interventions.
- Limited data exists from small observational studies.
Purpose of the Study:
- To systematically review and meta-analyze clinical outcomes of PBD versus HM in pediatric achalasia.
- To compare reoperation, symptom recurrence, GERD, and complications.
- To inform optimal treatment strategies for achalasia in children.
Main Methods:
- Systematic review and meta-analysis of PubMed, EMBASE, and Cochrane databases.
- Inclusion of comparative studies on PBD and HM in patients under 18.
- Random-effects models used to analyze outcomes from nine observational studies (317 patients).
Main Results:
- Heller's myotomy (HM) showed significantly lower odds of reoperation (OR=11.01) and symptom recurrence (OR=8.00).
- Pneumatic balloon dilation (PBD) was associated with a lower risk of GERD (OR=0.14).
- No significant difference in perforation rates; heterogeneity noted in study designs and reporting.
Conclusions:
- HM offers better long-term efficacy regarding recurrence and reoperation in pediatric achalasia.
- PBD may be preferable for reducing GERD risk.
- High-quality, prospective multicenter studies are essential due to current evidence limitations.
Abstract:
The optimal surgical treatment for achalasia in children remains controversial. Pneumatic balloon dilation (PBD) and Heller's myotomy (HM) are the most commonly used interventions, but comparative evidence is limited and based mainly on small observational studies.This study aimed to compare clinical outcomes of PBD and HM in children with achalasia through a systematic review and meta-analysis.PubMed, EMBASE, and Cochrane were searched through June 2025. Comparative studies evaluating PBD and HM in patients younger than 18 years were included. Outcomes of interest included symptom recurrence, reoperation, gastroesophageal reflux disease (GERD), and complications. Random-effects models were used due to expected heterogeneity.Nine observational studies comprising 317 patients were included (PBD: 184; HM: 133). HM was associated with lower odds of reoperation (odds ratio [OR] = 11.01; 95% confidence interval [CI]: 6.01-20.17; p = 0.0001) and symptom recurrence (OR = 8.00; 95% CI: 1.65-38.75; p = 0.0098). PBD was associated with a lower risk of GERD (OR = 0.14; CI: 0.02-0.98; p = 0.0477). No significant differences were observed in perforation rates. All studies were retrospective cohorts with heterogeneous reporting of techniques and outcomes, and some analyses were based on a limited number of studies.HM was associated with lower recurrence and reoperation rates, while PBD showed a lower risk of GERD. However, evidence is limited by small observational studies, with heterogeneity in treatment techniques, outcome definitions, and follow-up durations. Results should be interpreted cautiously, and prospective multicenter studies are needed to determine the optimal treatment strategy.
