Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(07): E1097-E1107
DOI: 10.1055/a-1483-9406
Original article

Peroral endoscopic myotomy (POEM) vs pneumatic dilation (PD) in treatment of achalasia: A meta-analysis of studies with ≥ 12-month follow-up

Andrew Ofosu‡
 1   Gastroenterology and Hepatology, Stanford University, Stanford, California, United States
,
Babu P. Mohan‡
 2   Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, Utah, United States
,
Yervant Ichkhanian
 3   Internal Medicine, Henry Ford University Medical Center, Detroit, Michigan, United States
,
Maen Masadeh
 4   Kaiser Permanente Northern California, California, United States
,
John Febin
 1   Gastroenterology and Hepatology, Stanford University, Stanford, California, United States
,
Mohamed Barakat
 1   Gastroenterology and Hepatology, Stanford University, Stanford, California, United States
,
Daryl Ramai
 1   Gastroenterology and Hepatology, Stanford University, Stanford, California, United States
,
Saurabh Chandan
 5   Gastroenterology and Hepatology, University of Nebraska, United States
,
Gulara Haiyeva
 6   Beneficts Hospital Inc., Great Falls, Montana, United States
,
Shahab R. Khan
 7   Gastroenterology, Rush University Medical Center, Chicago, Illinois, United States
,
Mohamad Aghaie Meybodi
 8   Gastroenterology and Hepatology, John Hopkins University Hospital, Baltimore, Maryland, United States
,
Antonio Facciorusso
 9   Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
,
Alessandro Repici
10   Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy
,
Sachin Wani
11   Gastroenterology, University of Colorado School of Medicine, Aurora, Colorado, United States
,
Nirav Thosani
12   Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, Houston, Texas, United States
,
Mouen A. Khashab
 8   Gastroenterology and Hepatology, John Hopkins University Hospital, Baltimore, Maryland, United States
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims Peroral endoscopic myotomy (POEM) is increasingly being used as the preferred treatment option for achalasia. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of POEM versus pneumatic balloon dilation (PD).

Methods We performed a comprehensive review of studies that reported clinical outcomes of POEM and PD for the treatment of achalasia. Measured outcomes included clinical success (improvement of symptoms based on a validated scale including an Eckardt score ≤ 3), adverse events, and post-treatment gastroesophageal reflux disease (GERD).

Results Sixty-six studies (6268 patients) were included in the final analysis, of which 29 studies (2919 patients) reported on POEM and 33 studies (3050 patients) reported on PD and 4 studies (299 patients) compared POEM versus PD. Clinical success with POEM was superior to PD at 12, 24, and 36 months (92.9 %, vs 76.9 % P = 0.001; 90.6 % vs 74.8 %, P = 0.004; 88.4 % vs 72.2 %, P = 0.006, respectively). POEM was superior to PD in type I, II and III achalasia (92.7 % vs 61 %, P = 0.01; 92.3 % vs 80.3 %, P = 0.01; 92.3 %v 41.9 %, P = 0.01 respectively)

Pooled OR of clinical success at 12 and 24 months were significantly higher with POEM (8.97; P = 0.001 & 5.64; P = 0.006). Pooled OR of GERD was significantly higher with POEM (by symptoms: 2.95, P = 0.02 and by endoscopic findings: 6.98, P = 0.001). Rates of esophageal perforation (0.3 % vs 0.6 %, P = 0.8) and significant bleeding (0.4 % vs 0.7 %, P = 0.56) were comparable between POEM and PD groups.

Conclusions POEM is more efficacious than PD in the treatment of patients with achalasia during short-term and long-term follow-up, albeit with higher risk of abnormal esophageal acid exposure.

Supplementary material



Publication History

Received: 22 July 2020

Accepted: 23 November 2020

Article published online:
21 June 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol 2013; 108: 1238-1249 quiz 50
    CrossrefPubMedGoogle Scholar
  • 2 Fisichella PM, Raz D, Palazzo F. et al. Clinical, radiological, and manometric profile in 145 patients with untreated achalasia. World J Surg 2008; 32: 1974-1979
    CrossrefPubMedGoogle Scholar
  • 3 Sadowski DC, Ackah F, Jiang B. et al. Achalasia: incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil 2010; 22: e256-e261
    CrossrefPubMedGoogle Scholar
  • 4 Boeckxstaens GE, Zaninotto G, Richter JE. Achalasia. Lancet 2014; 383: 83-93
    CrossrefPubMedGoogle Scholar
  • 5 Cheng JW, Li Y, Xing WQ. et al. Laparoscopic Heller myotomy is not superior to pneumatic dilation in the management of primary achalasia: Conclusions of a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2017; 96: e5525
    Google Scholar
  • 6 Inoue H, Minami H, Kobayashi Y. et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010; 42: 265-271
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Stavropoulos SN, Desilets DJ, Fuchs KH. et al. Per-oral endoscopic myotomy white paper summary. Gastrointest Endosc 2014; 80: 1-15
    CrossrefPubMedGoogle Scholar
  • 8 Moher D, Liberati A, Tetzlaff J. et al. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Ann Int Med 2009; 151: 264-269
    CrossrefPubMedGoogle Scholar
  • 9 Stroup DF, Berlin JA, Morton SC. et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283: 2008-2012
    CrossrefPubMedGoogle Scholar
  • 10 Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25: 603-605
    CrossrefPubMedGoogle Scholar
  • 11 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
    CrossrefPubMedGoogle Scholar
  • 12 Glenny AM, Altman DG, Song F. et al. Indirect comparisons of competing interventions. Health Technol Assess 2005; 9: 1-134
    CrossrefPubMedGoogle Scholar
  • 13 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188
    CrossrefPubMedGoogle Scholar
  • 14 Sutton AJ, Jones DR. et al. Methods for Meta-Analysis in Medical Research. Wiley; 2000: 348
    Google Scholar
  • 15 Higgins JP, Thompson SG, Spiegelhalter DJ. A re-evaluation of random-effects meta-analysis. J R Stat Soc Ser A Stat Soc 2009; 172: 137-159
    CrossrefPubMedGoogle Scholar
  • 16 Riley RD, Higgins JP, Deeks JJ. Interpretation of random effects meta-analyses. BMJ 2011; 342-549
    PubMedGoogle Scholar
  • 17 Mohan BP, Adler DG. Heterogeneity in systematic review and meta-analysis: how to read between the numbers. Gastrointest Endosc 2019; 89: 902-903
    CrossrefPubMedGoogle Scholar
  • 18 Kanwal F, White D. “Systematic Reviews and Meta-analyses” in Clinical Gastroenterology and Hepatology. Clin Gastroenterol Hepatol 2012; 10: 1184-1186
    CrossrefPubMedGoogle Scholar
  • 19 Higgins JP, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560
    CrossrefPubMedGoogle Scholar
  • 20 Guyatt GH, Oxman AD, Kunz R. et al. GRADE guidelines: 7. Rating the quality of evidence--inconsistency. J Clin Epidemiol 2011; 64: 1294-1302
    CrossrefPubMedGoogle Scholar
  • 21 Easterbrook PJ, Berlin JA, Gopalan R. et al. Publication bias in clinical research. Lancet 1991; 337: 867-872
    CrossrefPubMedGoogle Scholar
  • 22 Duval S, Tweedie R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000; 56: 455-463
    CrossrefPubMedGoogle Scholar
  • 23 Borenstein M. Publication Bias in Meta-Analysis: Prevention, Assessment and Adjustments. Rothstein HR. Wiley; 2005: 376
    Google Scholar
  • 24 de Pascale S, Repici A, Puccetti F. et al. Peroral endoscopic myotomy versus surgical myotomy for primary achalasia: single-center, retrospective analysis of 74 patients. Dis Esophagus 2017; 30: 1-7
    CrossrefPubMedGoogle Scholar
  • 25 Gulati S, Emmanuel A, Inoue H. et al. Peroral endoscopic myotomy: a literature review and the first UK case series. Clin Med (Lond) 2017; 17: 22-28
    CrossrefPubMedGoogle Scholar
  • 26 Guo H, Yang H, Zhang X. et al. Long-term outcomes of peroral endoscopic myotomy for patients with achalasia: a retrospective single-center study. Dis Esophagus 2017; 30: 1-6
    CrossrefPubMedGoogle Scholar
  • 27 Hungness ES, Sternbach JM, Teitelbaum EN. et al. Per-oral endoscopic myotomy (POEM) after the learning curve: durable long-term results with a low complication rate. Ann Surg 2016; 264: 508-517
    CrossrefPubMedGoogle Scholar
  • 28 Inoue H, Sato H, Ikeda H. et al. Per-oral endoscopic myotomy: a series of 500 patients. J Am Coll Surg 2015; 221: 256-264
    CrossrefPubMedGoogle Scholar
  • 29 Kumagai K, Tsai JA, Thorell A. et al. Per-oral endoscopic myotomy for achalasia. Are results comparable to laparoscopic Heller myotomy? . Scand J Gastroenterol 2015; 50: 505-512
    CrossrefPubMedGoogle Scholar
  • 30 Louie BE, Schneider AM, Schembre DB. et al. Impact of prior interventions on outcomes during per oral endoscopic myotomy. Surg Endosc 2017; 31: 1841-1848
    CrossrefPubMedGoogle Scholar
  • 31 Lv L, Liu J, Tan Y. et al. Peroral endoscopic full-thickness myotomy for the treatment of sigmoid-type achalasia: outcomes with a minimum follow-up of 12 months. Eur J Gastroenterol Hepatol 2016; 28: 30-36
    CrossrefPubMedGoogle Scholar
  • 32 Meng F, Li P, Wang Y. et al. Peroral endoscopic myotomy compared with pneumatic dilation for newly diagnosed achalasia. Surg Endosc 2017; 31: 4665-4672
    CrossrefPubMedGoogle Scholar
  • 33 Patel KS, Calixte R, Modayil RJ. et al. The light at the end of the tunnel: a single-operator learning curve analysis for per oral endoscopic myotomy. Gastrointest Endosc 2015; 81: 1181-1187
    CrossrefPubMedGoogle Scholar
  • 34 Peng L, Tian S, Du C. et al. Outcome of peroral endoscopic myotomy (POEM) for treating achalasia compared with laparoscopic heller myotomy (LHM). Surg Laparosc Endosc Percutan Tech 2017; 27: 60-64
    CrossrefPubMedGoogle Scholar
  • 35 Ponds FA, Fockens P, Lei A. et al. Effect of peroral endoscopic myotomy vs pneumatic dilation on symptom severity and treatment outcomes among treatment-naive patients with achalasia: a randomized clinical trial. JAMA 2019; 322: 134-144
    CrossrefPubMedGoogle Scholar
  • 36 Wang X, Tan Y, Lv L. et al. Peroral endoscopic myotomy versus pneumatic dilation for achalasia in patients aged ≥ 65 years. Rev Esp Enferm Dig 2016; 108: 637-641
    CrossrefPubMedGoogle Scholar
  • 37 Ward MA, Gitelis M, Patel L. et al. Outcomes in patients with over 1-year follow-up after peroral endoscopic myotomy (POEM). Surg Endosc 2017; 31: 1550-1557
    CrossrefPubMedGoogle Scholar
  • 38 Zheng Z, Zhao C, Su S. et al. Peroral endoscopic myotomy versus pneumatic dilation – result from a retrospective study with 1-year follow-up. Z Gastroenterol 2019; 57: 304-311
    Article in Thieme ConnectPubMedGoogle Scholar
  • 39 Ramchandani M, Nageshwar Reddy D, Darisetty S. et al. Peroral endoscopic myotomy for achalasia cardia: Treatment analysis and follow up of over 200 consecutive patients at a single center. Dig Endosc 2016; 28: 19-26
    CrossrefPubMedGoogle Scholar
  • 40 Ngamruengphong S, Inoue H, Ujiki MB. et al. Efficacy and safety of peroral endoscopic myotomy for treatment of achalasia after failed Heller myotomy. Clin Gastroenterol Hepatol 2017; 15: 1531-1537
    CrossrefPubMedGoogle Scholar
  • 41 Sharata AM, Dunst CM, Pescarus R. et al. Peroral endoscopic myotomy (POEM) for esophageal primary motility disorders: analysis of 100 consecutive patients. J Gastrointest Surg 2015; 19: 161-170 discussion 70
    CrossrefPubMedGoogle Scholar
  • 42 Duan T, Tan Y, Zhou J. et al. A retrospective study of peroral endoscopic full-thickness myotomy in patients with severe achalasia. J Laparoendosc Adv Surg Tech A 2017; 27: 770-776
    CrossrefPubMedGoogle Scholar
  • 43 Tang X, Gong W, Deng Z. et al. Feasibility and safety of peroral endoscopic myotomy for achalasia after failed endoscopic interventions. Dis Esophagus 2017; 30: 1-6
    PubMedGoogle Scholar
  • 44 Tang X, Ren Y, Gao Q. et al. Peroral endoscopic myotomy is safe and effective in achalasia patients aged older than 60 years compared with younger patients. Geriatr Gerontol Int 2017; 17: 2407-2413
    CrossrefPubMedGoogle Scholar
  • 45 Zhang X, Modayil RJ, Friedel D. et al. Per-oral endoscopic myotomy in patients with or without prior Hellerʼs myotomy: comparing long-term outcomes in a large U.S. single-center cohort (with videos). Gastrointest Endosc 2018; 87: 972-985
    CrossrefPubMedGoogle Scholar
  • 46 Alderliesten J, Conchillo JM, Leeuwenburgh I. et al. Predictors for outcome of failure of balloon dilatation in patients with achalasia. Gut 2011; 60: 10-16
    CrossrefPubMedGoogle Scholar
  • 47 Aljebreen AM, Samarkandi S, Al-Harbi T. et al. Efficacy of pneumatic dilatation in Saudi achalasia patients. Saudi J Gastroenterol 2014; 20: 43-47
    CrossrefPubMedGoogle Scholar
  • 48 Andreevski V, Nojkov B, Krstevski M. et al. Short and medium-term therapeutic effects of pneumatic dilatation for achalasia: a 15-year tertiary centre experience. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2013; 34: 15-22
    PubMedGoogle Scholar
  • 49 Borges AA, Lemme EM, Abrahao LJ. et al. Pneumatic dilation versus laparoscopic Heller myotomy for the treatment of achalasia: variables related to a good response. Dis Esophagus 2014; 27: 18-23
    CrossrefPubMedGoogle Scholar
  • 50 Bravi I, Nicita MT, Duca P. et al. A pneumatic dilation strategy in achalasia: prospective outcome and effects on oesophageal motor function in the long term. Aliment Pharmacol Ther 2010; 31: 658-665
    CrossrefPubMedGoogle Scholar
  • 51 Chen X, Li QP, Ji GZ. et al. Two-year follow-up for 45 patients with achalasia who underwent peroral endoscopic myotomy. Eur J Cardiothorac Surg 2015; 47: 890-896
    CrossrefPubMedGoogle Scholar
  • 52 Chuah SK, Hu TH, Wu KL. et al. Clinical remission in endoscope-guided pneumatic dilation for the treatment of esophageal achalasia: 7-year follow-up results of a prospective investigation. J Gastrointest Surg 2009; 13: 862-867
    CrossrefPubMedGoogle Scholar
  • 53 Dagli U, Kuran S, Savas N. et al. Factors predicting outcome of balloon dilatation in achalasia. Dig Dis Sci 2009; 54: 1237-1242
    CrossrefPubMedGoogle Scholar
  • 54 Dobrucali A, Erzin Y, Tuncer M. et al. Long-term results of graded pneumatic dilatation under endoscopic guidance in patients with primary esophageal achalasia. World J Gastroenterol 2004; 10: 3322-3327
    CrossrefPubMedGoogle Scholar
  • 55 Doder R, Perisic N, Tomasevic R. et al. Long-term outcome of a modified balloon dilatation in the treatment of patients with achalasia. Vojnosanit Pregl 2013; 70: 915-922
    CrossrefPubMedGoogle Scholar
  • 56 Elliott TR, Wu PI, Fuentealba S. et al. Long-term outcome following pneumatic dilatation as initial therapy for idiopathic achalasia: an 18-year single-centre experience. Aliment Pharmacol Ther 2013; 37: 1210-1219
    CrossrefPubMedGoogle Scholar
  • 57 Ghoshal UC, Rangan M, Misra A. Pneumatic dilation for achalasia cardia: reduction in lower esophageal sphincter pressure in assessing response and factors associated with recurrence during long-term follow up. Dig Endosc 2012; 24: 7-15
    CrossrefPubMedGoogle Scholar
  • 58 Hamdy E, El Nakeeb A, El Hanfy E. et al. Comparative study between laparoscopic heller myotomy versus pneumatic dilatation for treatment of early achalasia: a prospective randomized study. J Laparoendosc Adv Surg Tech A 2015; 25: 460-464
    CrossrefPubMedGoogle Scholar
  • 59 Hassan MK, Khattak MA, Bakhtiar S. et al. Long term results of single session of pneumatic dilatation with 30 MM balloon for achalasia cardia. J Postgrad Med Instit (Peshawar-Pakistan) 2017; 31
    PubMedGoogle Scholar
  • 60 Howard JM, Mongan AM, Manning BJ. et al. Outcomes in achalasia from a surgical unit where pneumatic dilatation is first-line therapy. Dis Esophagus 2010; 23: 465-472
    CrossrefPubMedGoogle Scholar
  • 61 Hulselmans M, Vanuytsel T, Degreef T. et al. Long-term outcome of pneumatic dilation in the treatment of achalasia. Clin Gastroenterol Hepatol 2010; 8: 30-35
    CrossrefPubMedGoogle Scholar
  • 62 Karamanolis G, Sgouros S, Karatzias G. et al. Long-term outcome of pneumatic dilation in the treatment of achalasia. Am J Gastroenterol 2005; 100: 270-274
    CrossrefPubMedGoogle Scholar
  • 63 Khashab MA, Kumbhari V, Tieu AH. et al. Peroral endoscopic myotomy achieves similar clinical response but incurs lesser charges compared to robotic heller myotomy. Saudi J Gastroenterol 2017; 23: 91
    PubMedGoogle Scholar
  • 64 Li SW, Tseng PH, Chen CC. et al. Muscular thickness of lower esophageal sphincter and therapeutic outcomes in achalasia: A prospective study using high-frequency endoscopic ultrasound. J Gastroenterol Hepatol 2018; 33: 240-248
    CrossrefPubMedGoogle Scholar
  • 65 Ling TS, Guo HM, Yang T. et al. Effectiveness of peroral endoscopic myotomy in the treatment of achalasia: a pilot trial in Chinese Han population with a minimum of one-year follow-up. J Dig Dis 2014; 15: 352-358
    CrossrefPubMedGoogle Scholar
  • 66 Maris T, Kapetanos D, Ilias A. et al. Mid term results of pneumatic balloon dilatation in patients with achalasia. Ann Gastroenterol 2010; 61-63
    PubMedGoogle Scholar
  • 67 Mikaeli J, Bishehsari F, Montazeri G. et al. Injection of botulinum toxin before pneumatic dilatation in achalasia treatment: a randomized-controlled trial. Aliment Pharmacol Ther 2006; 24: 983-989
    CrossrefPubMedGoogle Scholar
  • 68 Moonen A, Annese V, Belmans A. et al. Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut 2016; 65: 732-739
    CrossrefPubMedGoogle Scholar
  • 69 Novais PA, Lemme EM. 24-h pH monitoring patterns and clinical response after achalasia treatment with pneumatic dilation or laparoscopic Heller myotomy. Aliment Pharmacol Ther 2010; 32: 1257-1265
    CrossrefPubMedGoogle Scholar
  • 70 Park JH, Lee YC, Lee H. et al. Residual lower esophageal sphincter pressure as a prognostic factor in the pneumatic balloon treatment of achalasia. J Gastroenterol Hepatol 2015; 30: 59-63
    CrossrefPubMedGoogle Scholar
  • 71 Persson J, Johnsson E, Kostic S. et al. Treatment of achalasia with laparoscopic myotomy or pneumatic dilatation: long-term results of a prospective, randomized study. World J Surg 2015; 39: 713-720
    CrossrefPubMedGoogle Scholar
  • 72 Sabharwal T, Cowling M, Dussek J. et al. Balloon dilation for achalasia of the cardia: experience in 76 patients. Radiology 2002; 224: 719-724
    CrossrefPubMedGoogle Scholar
  • 73 Schneider AM, Louie BE, Warren HF. et al. A matched comparison of per oral endoscopic myotomy to laparoscopic Heller myotomy in the treatment of achalasia. J Gastrointest Surg 2016; 20: 1789-1796
    CrossrefPubMedGoogle Scholar
  • 74 Shejal AH, Ramachandran TM, Kumar S. Clinical outcome of pneumatic dilatation in patients with achalasia cardia: A single-center prospective study. J Digest Endosc 2017; 8: 182-186
    Article in Thieme ConnectPubMedGoogle Scholar
  • 75 Spiliopoulos S, Sabharwal T, Inchingolo R. et al. Fluoroscopically guided balloon dilatation for the treatment of achalasia: long-term outcomes. Dis Esophagus 2013; 26: 213-218
    CrossrefPubMedGoogle Scholar
  • 76 Tanaka Y, Iwakiri K, Kawami N. et al. Predictors of a better outcome of pneumatic dilatation in patients with primary achalasia. J Gastroenterol 2010; 45: 153-158
    CrossrefPubMedGoogle Scholar
  • 77 Teitelbaum EN, Soper NJ, Santos BF. et al. Symptomatic and physiologic outcomes one year after peroral esophageal myotomy (POEM) for treatment of achalasia. Surg Endosc 2014; 28: 3359-3365
    CrossrefPubMedGoogle Scholar
  • 78 von Renteln D, Fuchs KH, Fockens P. et al. Peroral endoscopic myotomy for the treatment of achalasia: an international prospective multicenter study. Gastroenterology 2013; 145: 309-11.e1-3
    CrossrefPubMedGoogle Scholar
  • 79 Werner YB, von Renteln D, Noder T. et al. Early adverse events of per-oral endoscopic myotomy. Gastrointest Endosc 2017; 85: 708-18.e2
    CrossrefPubMedGoogle Scholar
  • 80 Worrell SG, Alicuben ET, Boys J. et al. Peroral endoscopic myotomy for achalasia in a thoracic surgical practice. Ann Thorac Surg 2016; 101: 218-24 ; discussion 24–25
    CrossrefPubMedGoogle Scholar
  • 81 Yamashita H, Ashida K, Fukuchi T. et al. Predictive factors associated with the success of pneumatic dilatation in Japanese patients with primary achalasia: a study using high-resolution manometry. Digestion 2013; 87: 23-28
    CrossrefPubMedGoogle Scholar
  • 82 Zerbib F, Thetiot V, Richy F. et al. Repeated pneumatic dilations as long-term maintenance therapy for esophageal achalasia. Am J Gastroenterol 2006; 101: 692-697
    CrossrefPubMedGoogle Scholar
  • 83 Kim WH, Cho JY, Ko WJ. et al. Comparison of the outcomes of peroral endoscopic myotomy for achalasia according to manometric subtype. Gut Liver 2017; 11: 642-647
    CrossrefPubMedGoogle Scholar
  • 84 Lee JY, Kim N, Kim SE. et al. Clinical characteristics and treatment outcomes of 3 subtypes of achalasia according to the Chicago classification in a tertiary institute in Korea. J Neurogastroenterol Motil 2013; 19: 485-494
    CrossrefPubMedGoogle Scholar
  • 85 Martinek J, Svecova H, Vackova Z. et al. Per-oral endoscopic myotomy (POEM): mid-term efficacy and safety. Surg Endosc 2018; 32: 1293-1302
    CrossrefPubMedGoogle Scholar
  • 86 Muller M, Keck C, Eckardt AJ. et al. Outcomes of pneumatic dilation in achalasia: Extended follow-up of more than 25 years with a focus on manometric subtypes. J Gastroenterol Hepatol 2018; 33: 1067-1074
    CrossrefPubMedGoogle Scholar
  • 87 Nabi Z, Ramchandani M, Chavan R. et al. Peroral endoscopic myotomy in treatment-naive achalasia patients versus prior treatment failure cases. Endoscopy 2018; 50: 358-370
    Article in Thieme ConnectPubMedGoogle Scholar
  • 88 Pandolfino JE, Kwiatek MA, Nealis T. et al. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology 2008; 135: 1526-1533
    CrossrefPubMedGoogle Scholar
  • 89 Rohof WO, Salvador R, Annese V. et al. Outcomes of treatment for achalasia depend on manometric subtype. Gastroenterology 2013; 144: 718-725 quiz e13-4
    CrossrefPubMedGoogle Scholar
  • 90 Ghoshal UC, Rangan M. A review of factors predicting outcome of pneumatic dilation in patients with achalasia cardia. J Neurogastroenterol Motil 2011; 17: 9-13
    CrossrefPubMedGoogle Scholar
  • 91 Zhang WG, Linghu EQ, Chai NL. et al. Ling classification describes endoscopic progressive process of achalasia and successful peroral endoscopy myotomy prevents endoscopic progression of achalasia. World J Gastroenterol 2017; 23: 3309-3314
    CrossrefPubMedGoogle Scholar
  • 92 Kim WH, Cho JY, Ko WJ. et al. Comparison of the outcomes of peroral endoscopic myotomy for achalasia according to manometric subtype. Gut Liver 2017; 11: 642-647
    CrossrefPubMedGoogle Scholar
  • 93 Kahrilas PJ, Katzka D, Richter JE. Clinical practice update: the use of per-oral endoscopic myotomy in achalasia: expert review and best practice advice from the AGA Institute. Gastroenterology 2017; 153: 1205-1211
    CrossrefPubMedGoogle Scholar
  • 94 Tyberg A, Choi A, Gaidhane M. et al. Transoral Incisionless fundoplication for reflux after peroral endoscopic myotomy: a crucial addition to our arsenal. Endosc Int Open 2018; 6: E549-E552
    Article in Thieme ConnectPubMedGoogle Scholar