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Treating achalasia: from whalebone to laparoscope
1Department of Medicine, Northwestern University Medical School, Chicago, Ill 60611-3053, USA.
JAMA
|August 26, 1998
Summary
Pneumatic dilation and Heller myotomy are effective achalasia treatments. Laparoscopic Heller myotomy is the optimal surgical therapy, offering superior symptom resolution compared to dilation.
Area of Science:
- Gastroenterology
- Esophageal Motility Disorders
- Surgical Innovation
Background:
- Achalasia is caused by the destruction of esophageal myenteric plexus neurons.
- This destruction leads to aperistalsis and impaired lower esophageal sphincter relaxation.
Purpose of the Study:
- To review the pathophysiology of achalasia.
- To evaluate the management and therapeutic efficacy of achalasia treatments.
Main Methods:
- A comprehensive literature search was conducted on MEDLINE for peer-reviewed publications on achalasia from 1966 to 1997.
- 4.5% of identified citations were selected for detailed review, focusing on new developments and therapeutic efficacy in trials or series with at least 10 patients followed for a year or longer.
Main Results:
- Both pneumatic dilation and Heller myotomy are effective in managing achalasia.
- A controlled trial indicated surgery (95% symptom resolution) is superior to dilation (51% resolution).
- Uncontrolled trials showed pneumatic dilation effectiveness at 72% and Heller myotomy at 84%, with laparoscopic techniques reducing surgical morbidity.
Conclusions:
- Pneumatic dilation and surgical myotomy are established effective therapies for achalasia.
- Laparoscopic Heller myotomy is emerging as the preferred surgical approach due to reduced morbidity and high efficacy.