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Heller's Myotomy Not Superior Treatment for Achalasia

Therapeutic success rate similar to pneumatic dilation

THURSDAY, May 12 (HealthDay News) -- Laparoscopic Heller's myotomy (LHM) appears no more effective than pneumatic dilation for treatment of achalasia, according to research published in the May 12 issue of the New England Journal of Medicine.

Guy E. Boeckxstaens, M.D., Ph.D., from the Academic Medical Center in Amsterdam, Netherlands, and colleagues randomly assigned 201 patients with newly diagnosed achalasia to pneumatic dilation or LHM with Dor's fundoplication to assess whether the latter, which is considered by many experts to be the superior treatment, is any better than the former.

After a mean follow-up of 43 months, the researchers observed no significant differences between the two groups in terms of therapeutic success indicated by a drop in Eckardt scores. And after two years of follow-up, the researchers found no significant difference between the groups in terms of pressure at the lower esophageal sphincter, esophageal emptying, pneumatic dilation, or quality of life. In the pneumatic dilation group, 4 percent of patients had perforation of the esophagus, and in the LHM group, 12 percent of patients had LHM.

"After two years of follow-up, LHM, as compared with pneumatic dilation, was not associated with superior rates of therapeutic success," the authors write.

Three authors disclosed financial relationships with pharmaceutical companies.

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