TY - JOUR T1 - Highlights from the literature JF - Frontline Gastroenterology JO - Frontline Gastroenterol SP - 255 LP - 256 DO - 10.1136/flgastro-2020-101773 VL - 12 IS - 3 AU - Ayodele Sasegbon AU - Dipesh Harshvadan Vasant Y1 - 2021/05/01 UR - http://fg.bmj.com/content/12/3/255.abstract N2 - Recent advances in motility diagnostics and novel endoscopic approaches have revolutionised the landscape for the management of idiopathic achalasia. In this context, Mundre et al1 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 equally efficacious and should be considered … ER -