Article Text

other Versions

PDF
Treating achalasia; more than just flipping a coin
  1. Peter J Kahrilas
  1. Correspondence to Dr Peter J Kahrilas, Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Feinberg School of Medicine, 676 N. St. Clair Street, 14th Floor, Chicago, IL 60611, USA; p-kahrilas{at}northwestern.edu

Statistics from Altmetric.com

Even as the preferred treatment of achalasia migrates towards per-oral endoscopic myotomy (POEM), the relative merits of pneumatic dilation (PD) and laparoscopic Heller myotomy (LHM) continue to be argued. In this issue of Gut, the long-term results of the European achalasia trial comparing 201 patients randomised to PD or LHM are presented,1 reporting similar outcomes between therapies. After a minimum follow-up of 5 years, 82% of patients with PD and 84% of patients with LHM had a sustained good response when analysed by intention to treat (or 91% of patients with PD and 82% of patients with LHM when analysed per protocol). The outcomes being similar, the authors conclude that the decision between therapies should be based on available expertise and patient preference. Certainly, this was an important trial and an important result. Equally certain, the medical-surgical debate will continue. Assessing the adequacy of treatment in achalasia has many facets. There are many ways to look at it and, most assuredly, surgeons and gastroenterologists will not look at these data the same way.

The ideal therapy for achalasia would revert swallow function to normal, render the patient symptom-free and not result in pathological reflux. No current therapy achieves this and none on the horizon is likely to do so. …

View Full Text

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles