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Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Dec 14, 2008; 14(46): 7122-7126
Published online Dec 14, 2008. doi: 10.3748/wjg.14.7122
Recurrent achalasia treated with Heller myotomy: A review of the literature
Lan Wang, You-Ming Li
Lan Wang, You-Ming Li, Department of Gastroenterology, the First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Author contributions: Wang L was responsible for data collection and preparing the manuscript; Li YM was responsible for study design; all of the authors read and approved the final manuscript.
Correspondence to: You-Ming Li, The First Affiliated Hospital, Medical College, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. zlym@zju.edu.cn
Telephone: +86-571-87236603 Fax: +86-571-87236603
Received: September 4, 2008
Revised: October 16, 2008
Accepted: October 23, 2008
Published online: December 14, 2008

AIM: To evaluate the efficacy and safety of Heller myotomy (HM) for recurrent achalasia, performed after different methods of first-line treatment.

METHODS: We searched for studies published in PubMed from 1966 to March 2008 on treatment of recurrent achalasia with HM after failure with different methods of first-line treatment. The efficacy of HM was assessed by a pooled estimate of response rate with individual studies weighted proportionally to sample size.

RESULTS: Sixteen studies were eligible and included in the review. The results showed that HM has a better remission rate for recurrent achalasia after failure of HM [weighted mean (SD)] of 86.9% (21.8%) compared with 81.6% (23.8%) for pneumatic dilatation (PD). One study evaluated the efficacy of HM after failure of PD combined with botulinum toxin injection (83%). The most common complications were perforation and gastroesophageal reflux.

CONCLUSION: HM has the best efficacy in patients with recurrent achalasia who were treated with HM as first-line treatment. Future studies should focus on how to increase the success rate and decrease the complications of HM.

Keywords: Recurrent achalasia, Heller myotomy, Pneumatic dilatation