Is Heller Myotomy Better than Balloon Dilation? A Meta-Analysis

Abstract

Background & Aim: Endoscopic balloon dilation (EBD) and laparoscopic Heller myotomy (LHM) are the most commonly performed treatment options for achalasia. Decision between these treatment options is difficult. The aim of this meta-analysis was to evaluate the efficacy of EBD compared to LHM.
Methods: The electronic databases PubMed, Embase and Cochrane Controlled Trials Registry were systematically searched for the period between January 1, 1976 and December 31, 2015. Meta-analysis was performed using the PICOS (problem, intervention, comparison, outcome, study design) format. Efficacy and safety of EBD were compared to LHM. Forest plot analyses were used to illustrate the success rate, perforation rate and post-procedural gastroesophageal reflux.
Results: Using the search strategy, eight studies met the selection criteria and were included in the meta-analysis. The total number of patients included was 749 (360 in the EBD group and 389 in the LHM group). The success rate was lower in the EBD group than in the LHM group (OR=0.486; CI: 0.304-0.779; p=0.003). The rate of perforation did not differ significantly between the EBD and LHM group (RR= 0.635, CI: 0.340-1.186, p=0.154). The incidence of post-procedural symptomatic gastroesophageal reflux did not differ between the two treatment groups (RR=0.663, CI: 0.328-1.343, p=0.254).
Conclusion: Our data suggest that the efficacy of LHM is superior to that of EBD, while there is no difference in safety between the two treatment groups.
Abbreviations: EBD: endoscopic balloon dilation; GERD: gastro-esophageal reflux disease; LES: lower esophageal sphincter; LHM: laparascopic Heller myotomy; OR: odds ratio; PICOS: Problem, Intervention, Comparison, Outcome, Study design; POEM: Per Oral Endoscopic Myotomy; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analysis; RR: risk ratio.