TY - JOUR T1 - Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy JF - Gut JO - Gut SP - 732 LP - 739 DO - 10.1136/gutjnl-2015-310602 VL - 65 IS - 5 AU - An Moonen AU - Vito Annese AU - Ann Belmans AU - Albert J Bredenoord AU - Stanislas Bruley des Varannes AU - Mario Costantini AU - Bertrand Dousset AU - J I Elizalde AU - Uberto Fumagalli AU - Marianne Gaudric AU - Antonio Merla AU - Andre J Smout AU - Jan Tack AU - Giovanni Zaninotto AU - Olivier R Busch AU - Guy E Boeckxstaens Y1 - 2016/05/01 UR - http://gut.bmj.com/content/65/5/732.abstract N2 - Objective Achalasia is a chronic motility disorder of the oesophagus for which laparoscopic Heller myotomy (LHM) and endoscopic pneumodilation (PD) are the most commonly used treatments. However, prospective data comparing their long-term efficacy is lacking.Design 201 newly diagnosed patients with achalasia were randomly assigned to PD (n=96) or LHM (n=105). Before randomisation, symptoms were assessed using the Eckardt score, functional test were performed and quality of life was assessed. The primary outcome was therapeutic success (presence of Eckardt score ≤3) at the yearly follow-up assessment. The secondary outcomes included the need for re-treatment, lower oesophageal sphincter pressure, oesophageal emptying and the rate of complications.Results In the full analysis set, there was no significant difference in success rate between the two treatments with 84% and 82% success after 5 years for LHM and PD, respectively (p=0.92, log-rank test). Similar results were obtained in the per-protocol analysis (5-year success rates: 82% for LHM vs 91% for PD, p=0.08, log-rank test). After 5 years, no differences in secondary outcome parameter were observed. Redilation was performed in 24 (25%) of PD patients. Five oesophageal perforations occurred during PD (5%) while 12 mucosal tears (11%) occurred during LHM.Conclusions After at least 5 years of follow-up, PD and LHM have a comparable success rate with no differences in oesophageal function and emptying. However, 25% of PD patients require redilation during follow-up. Based on these data, we conclude that either treatment can be proposed as initial treatment for achalasia.Trial registration numbers Netherlands trial register (NTR37) and Current Controlled Trials registry (ISRCTN56304564). ER -