Esophagus to Small Intestine
Gut. 2024;73(4):582–9
10-year follow-up results of the European Achalasia Trial: A multicentre randomised controlled trial comparing pneumatic dilation with laparoscopic Heller myotomy
Objective: As achalasia is a chronic disorder, long-term follow-up data comparing different treatments are essential to select optimal clinical management. Here, the authors report on the 10-year follow-up of the European Achalasia Trial comparing endoscopic pneumatic dilation (PD) with laparoscopic Heller myotomy (LHM).
Design: A total of 201 newly diagnosed patients with achalasia were randomised to either a series of PDs (n = 96) or LHM (n = 105). Patients completed symptom (Eckardt score) and quality-of-life questionnaires, underwent functional tests and upper endoscopy. Primary outcome was therapeutic success defined as Eckardt score ≤ 3 at yearly follow-up. Secondary outcomes were the need for retreatment, lower oesophageal sphincter pressure, oesophageal emptying, gastro-oesophageal reflux and the rate of complications.
Results: After 10 years of follow-up, LHM (n = 40) and PD (n = 36) were equally effective in both the full analysis set (74% vs. 74%, p = 0.84) and the per protocol set (74% vs. 86%, respectively, p = 0.07). Subgroup analysis revealed that PD was superior to LHM for type 2 achalasia (p = 0.03) while there was a trend, although not significant (p = 0.05), that LHM performed better for type 3 achalasia. Barium column height after 5 minutes at timed barium oesophagram was significantly higher for patients treated with PD compared with LHM, while other parameters, including gastro-oesophageal reflux, were not different.
Conclusions: Pneumatic dilation (PD) and laparoscopic Heller myotomy (LHM) are equally effective even after 10 years of follow-up with limited risk to develop gastro-oesophageal reflux. Based on these data, it was concluded that PD and LHM can both be proposed as initial treatment of achalasia.