Frontline Gastroenterology | 2021
Highlights from the literature
Abstract
Network meta-analysis comparing surgical and endoscopic treatments in achalasia Recent advances in motility diagnostics and novel endoscopic approaches have revolutionised the landscape for the management of idiopathic achalasia. In this context, Mundre et al performed a network metaanalysis of randomised controlled trials (RCTs) comparing the efficacy of pneumatic dilatation (PD), peroral endoscopic myomectomy (POEM) and laparoscopic Heller myomectomy (LHM). Nine eligible RCTs comprising 911 patients were analysed and results were dichotomised into either treatment failure or success, after a minimum of 12 months of followup. A total of 317 patients underwent PD; 222 had POEM; and 372 had LHM. While POEM was least likely to result in treatment failure (relative risk (RR) 0.33, P-0.89) with LHM ranked second (RR 0.45, P-0.61), both POEM and LHM were superior to PD. There was no significant difference in the efficacy of POEM and LHM. There were no significant differences between the three treatments in terms of perforation rates, need for reintervention or serious adverse events. In summary, the authors report that POEM and LHM are equally efficacious and should be considered firstline treatment options for achalasia, depending on local expertise, patient choice and suitability for intervention.