Treating achalasia; more than just flipping a coin

Even as the preferred treatment of achalasia migrates towards per-oral endoscopic myotomy (POEM), the relative merits of pneumatic dilation (PD) and laparoscopic Heller myotomy (LHM) continue to be argued. In this issue of Gut, the long-term results of the European achalasia trial comparing 201 patients randomised to PD or LHM are presented,1 reporting similar outcomes between therapies. After a minimum follow-up of 5 years, 82% of patients with PD and 84% of patients with LHM had a sustained good response when analysed by intention to treat (or 91% of patients with PD and 82% of patients with LHM when analysed per protocol). The outcomes being similar, the authors conclude that the decision between therapies should be based on available expertise and patient preference. Certainly, this was an important trial and an important result. Equally certain, the medical-surgical debate will continue. Assessing the adequacy of treatment in achalasia has...
Source: Gut - Category: Gastroenterology Authors: Tags: Commentary Source Type: research