- 作者：Mohammad Yaghoobi ; Serge Mayr ; Myriam Martel ; Ira Roshan-Afshar ; Raheleh Bijarchi ; Alan Barkun
- 关键词：GER ; gastroesophageal reflux ; LES ; lower esophageal sphincter ; LHM ; laparoscopic Heller's myotomy ; PD ; pneumatic dilation ; QLQ-OES24 ; European Organisation for Research and Treatment of Cancer disease-specific questionnaire module ; SF-36 ; Medical Outcomes
- 刊名：Gastrointestinal Endoscopy
- 出版年：2013
- 出版时间：September, 2013
- 年：2013
- 卷：78
- 期：3
- 页码：468-475
- 全文大小：865 K
Background
Pneumatic dilation (PD) and laparoscopic Heller's myotomy (LHM) are the mainstays of therapy in idiopathic achalasia. Equipoise exists in choosing the first-line therapy.Objective
To assess comparative efficacies and adverse event rates of these methods.
Design
Intention-to-treat, fixed-model, Mantel-Haenszel meta-analysis of randomized, controlled trials comparing PD with LHM.
Setting
Randomized controlled trial comparing PD versus LHM.
Patients
Patients with newly diagnosed idiopathic achalasia.
Intervention
Comprehensive electronic and manual literature search from 1966 to March 2012 independently by two reviewers.
Main Outcome Measurements
Response rate, rate of different adverse events, and quality of life after each therapy.
Results
Three of 161 retrieved studies between 2007 and 2011, including 346 patients, were included. At 1 year, the cumulative response rate was significantly higher with LHM (86 % vs 76 % , odds ratio 1.98 (confidence interval 1.14-3.45); P?= .02), with no significant heterogeneity (P?= .39; I2 0 % ). Rates of major mucosal tears requiring subsequent intervention with LHM were significantly lower than those of esophageal perforation with PD requiring postprocedural medical or surgical therapy (0.6 % and 4.8 % , respectively; P?= .04). Postprocedural rates of gastroesophageal reflux, lower esophageal sphincter pressures, and quality of life scores did not differ in trials with sufficient data. Data on longer follow-up were not available.
Limitations
Lack of data on follow-ups over 1 year and a small number of included studies.
Conclusion
This meta-analysis suggests that LHM may provide greater response rates as compared with graded PD in the treatment of newly diagnosed idiopathic achalasia, with lesser rates of major adverse events, in up to 1?year after treatment, although additional data are needed to confirm the validity of this conclusion in long-term follow-up.