Pneumatic dilatation (PD) should always be the first choice for achalasia treatment. In the following section, we will compare PD to other common achalasia procedures: intersphincteric botox injections (BTX), laparoscopic heller myotomy (LHM), and peroral endoscopic myotomy (POEM). We will focus on the limitation of studies leaning toward those procedures, and how PD data has proven good efficacy and safety. Will also discuss how in certain populations PD should always be the first choice.
LevineMLDorfBSMoskowitzGBankS.Pneumatic dilatation in achalasia under endoscopic guidance: correlation pre- and postdilatation by radionuclide scintiscan. Am J Gastroenterol. 1987;82:311-314.
2.
EckardtVFGockelIBernhardG.Pneumatic dilation for achalasia: late results of a prospective follow up investigation. Gut. 2004;53:629-633.
3.
BoeckxstaensGEAnneseVdes VarannesSB, et al. European Achalasia Trial Investigators. Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med. 2011;364(19):1807-1816.
4.
StefanidisDRichardsonWFarrellTMKohnGPAugensteinVFanelliRD; Society of American Gastrointestinal and Endoscopic Surgeons. SAGES guidelines for the surgical treatment of esophageal achalasia. Surg Endosc. 2012;26:296-311.
5.
ChuahSKWuKLHuTHTaiWCChangchienCS.Endoscope-guided pneumatic dilation for treatment of esophageal achalasia. World J Gastroenterol. 2010;16(4):411-417.
6.
AllescherHDStorrMSeigeM, et al. Treatment of achalasia: botulinum toxin injection vs. pneumatic balloon dilation. A prospective study with long-term follow-up. Endoscopy. 2001;33(12):1007-1017.
7.
LeydenJEMossACMacMathunaP.Endoscopic pneumatic dilation versus botulinum toxin injection in the management of primary achalasia. Cochrane Database Syst Rev. 2014;12:CD005046. doi:10.1002/14651858.CD005046.pub3
8.
de HeerJDesaiMBoeckxstaensG, et al. Pneumatic balloon dilatation versus laparoscopic Heller myotomy for achalasia: a failed attempt at meta-analysis. Surg Endosc. 2021;35(2):602-611.
9.
van HoeijFBPrinsLISmoutAJPMBredenoordAJ.Efficacy and safety of pneumatic dilation in achalasia: a systematic review and meta-analysis. Neurogastroenterol Motil. 2019;31(7):e13548. doi:10.1111/nmo.13548
10.
SpechlerSJ.Pneumatic dilation and laparoscopic Heller’s myotomy equally effective for achalasia. N Engl J Med. 2011;364:1868-1870.
11.
MoonenAAnneseVBelmansA, et al. Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut. 2016;65:732-739.
12.
PondsFAFockensPLeiA, et al. Effect of peroral endoscopic myotomy vs pneumatic dilation on symptom severity and treatment outcomes among treatment-naive patients with achalasia: a randomized clinical trial. JAMA. 2019;322(2):134-144.
13.
WangXTanYLvL, et al. Peroral endoscopic myotomy versus pneumatic dilation for achalasia in patients aged ≥ 65 years. Rev Esp Enferm Dig. 2016;108:637-641.
14.
MengFLiPWangY, et al. Peroral endoscopic myotomy compared with pneumatic dilation for newly diagnosed achalasia. Surg Endosc. 2017;31:4665-4672.
15.
PodboyAJHwangJHRivasH, et al. Long-term outcomes of per-oral endoscopic myotomy compared to laparoscopic Heller myotomy for achalasia: a single-center experience. Surg Endosc. 2021;35:792-801.
16.
FacciorussoASinghSAbbas FehmiSMAnneseVLiphamJYadlapatiR.Comparative efficacy of first-line therapeutic interventions for achalasia: a systematic review and network meta-analysis. Surg Endosc. 2021;35(8):4305-4314. doi:10.1007/s00464-020-07920-x
17.
BhayaniNHKurianAADunstCMSharataAMRiederESwanstromLL.A comparative study on comprehensive, objective outcomes of laparoscopic Heller myotomy with peroral endoscopic myotomy (POEM) for achalasia. Ann Surg. 2014;259:1098-1103.
18.
BonifácioPde MouraDTHBernardoWM, et al. Pneumatic dilation versus laparoscopic Heller’s myotomy in the treatment of achalasia: systematic review and meta-analysis based on randomized controlled trials. Dis Esophagus. 2019;32(2):1.
19.
MaranoLPallabazzerGSolitoB, et al. Surgery or peroral esophageal myotomy for achalasia: a systematic review and meta-analysis. Medicine. 2016;95(10):e3001.
20.
PuhanMASchunemannHJMuradMH, et alFor the GRADE Working Group. A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis. BMJ. 2014;349:g5630.
21.
KohnGPDirksRCAnsariMT, et al. SAGES guidelines for the use of peroral endoscopic myotomy (POEM) for the treatment of achalasia. Surg Endosc. 2021;35:1931-1948. doi:10.1007/s00464-020-08282-0
22.
EckardtVFAignherrCBernhardG. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology. 1992;103:1732-1738.
23.
Oude NijhuisRABPrinsLIMostafaviN, et al. Factors associated with achalasia treatment outcomes: systematic review and meta-analysis. Clin Gastroenterol Hepatol.2020;18(7):1442-1453.
24.
VaeziMFBakerMERichterJE.Assessment of esophageal emptying post-pneumatic dilation: use of the timed barium esophagram. Am J Gastroenterol. 1999;94:1802-1807.
25.
KhanMAKumbhariVNgamruengphongS, et al. Is POEM the answer for management of spastic esophageal disorders? A systematic review and meta-analysis. Dig Dis Sci. 2017;62(1):35-44.
26.
EvensenHKristensenVLarssenLSandstadOHaugeTMedhusAW.Outcome of peroral endoscopic myotomy (POEM) in treatment-naive patients. A systematic review. Scand J Gastroenterol. 2019;54(1):1-7.
27.
BorgesAALemmeEMAbrahaoLJJr, et al. Pneumatic dilation versus laparoscopic Heller myotomy for the treatment of achalasia: variables related to a good response. Dis Esophagus. 2014;27(1):18-23.
