Pneumodilation versus laparoscopic Heller's myotomy for achalasia

Abstract

Boeckxstaens et al. (May 12 issue)1 compare single laparoscopic myotomy with a series of pneumodilation procedures for patients with achalasia. They found no significant difference in outcomes between the two groups, although perforation occurred in 4% of patients in the pneumodilation group and often required emergency treatment. No significant clinical adverse outcomes occurred in the surgical group. A previous study reported that 57% of patients who were treated surgically were free from further interventions at 6 years, as compared with only 28% of patients who underwent a single pneumodilation.2 Freedom from subsequent treatment did increase with graded pneumodilation. It remains to be seen what the durability of effect of pneumodilation will be in the current cohort. However, the requirement for repeated procedures would suggest that further treatments may well be needed to maintain a response. We suggest that one-time surgery with low clinical risk and median lengths of hospital stay between 1 and 4 days3,4 with potentially better durability may be more acceptable to patients, and indeed health economists, than repeated pneumodilation with its established risk profile. Eoin Slattery, M.D. Stephen E. Patchett, M.D. Beaumont Hospital, Dublin, Ireland slattery.eoin@gmail.com No potential conflict of interest relevant to this letter was reported.