Current status in the treatment options for esophageal achalasia

Table 1 Cumulative effectiveness of pneumatic dilations for treatment of achalasia by using low compliance “Rigiflex” dilators

No.	Type of dilator (size, cm)	Improvement excellent/good	Mean follow-up (yr)	Complication perforation	Ref.
125	3.0-4.0	50%	12.00%	0.01%	[27]
54	BMD	36%-40%	13.80%	0.02%	[13]
262	3.0-3.5	60%	4.50%	1.00%	[14]
66	3.0-4.0	79%	4.60%	5.00%	[15]
39	3.0-4.0	58.3%-78.0%	9.30%	5.40%	[24]
50	3.0-4.0	67%-83%	2.70%	0.00%	[25]
106	3.0-4.0	28%-62%	3.20%	2.80%	[28]
209	3.0-4.0	72%	5.80%	0.00%	[23]
55	3.0-3.5	74.50%	2.30%	0.00%	[22]
43	3.0-3.5	54%-78%	2.40%	2.30%	[17]
56	3.5	89.3%-92.9%	0.50%	0.00%	[21]
32	3.0	69%-91%	4.50%	3.30%	[20]
1097	3.0-4.0	28.0%-92.9%	0.5%-15.0%	1.0%-2.0%	Total

BMD: Browne-McHardy dilator.

Table 2 Cumulative effectiveness of surgical myotomy for achalasia

No.	Type of surgery	Improvement excellent/good	Mean follow-up (yr)	Complication acid reflux	Ref.
52	LHM-Dor operation	92%	4.3	11%	[51]
53	LHM-Dor operation	92%	3.0	9%	[61]
75	LHM-partial fundoplication	84%	5.6	15%	[48]
71	LHM-Dor	85%	6.0	12.70%	[52]
248	LHM+/-Dor	88%	3.4	3%	[55]
211	LHM-Dor	89%	5.3	34%	[56]
161	LHM-Dor	97.20%	4.6	15.70%	[47]
200	LHM-Dor	85%	3.5	28%	[57]
46	LHM-Toupet or Dor	80%	6.4	9%	[46]
505	LHM+/- fundoplication	95%	2.6	16%	[51]
155	LHM-Dor	77%	5.0	27%	[54]
137	LHM-Dor	94.80%	5.4	10.90%	[59]
1860	-	77%-97.2%	2.6-10.9	3%-34%	Total

LHM: Laparoscopic Heller myotomy.

Table 3 Summary of the cumulative efficacies and complications of current treatment options of achalasia

	PD	Surgical myotomy	BTI	POEM
No. of studies	12	12	9	11
No. of patients	1097	1860	315	210
Excellent/good symptom response (range)	28%-92.9%	77%-97.2%	At 1 mo: 79% (64%-93%) At 1 yr: 41% (10%-55%)	82%-100%
Follow up (yr)	0.5-15	2.6-10.9	18 (6-30)	0.1-1
Major complications (range)	1%-2% Perforation	3%-34% Acid reflux	-	0.03% Acid reflux

PD: Pneumatic dilations; BTI: Botulinium toxin injection; POEM: Peroral endoscopic myotomy.