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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 1 performed a network meta-analysis of randomised controlled trials (RCTs) comparing the efficacy of pneumatic dilatation (PD), per-oral 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 follow-up. 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 …
Contributors AS and DHV both performed literature review, selected the articles included and contributed to the composition of the paper. DHV is the supervising author and guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
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