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Endoscopic myotomy non-inferior to surgical myotomy for idiopathic achalasia

Current treatment options for achalasia include endoscopic pneumatic dilation and surgical laparoscopic Heller’s myotomy (LHM). A multicentre, randomized trial compared LHM plus Dor’s fundoplication with the less-invasive peroral endoscopic myotomy (POEM) in patients with idiopathic achalasia. The primary endpoint of clinical success at the 2-year follow-up was observed in 83.0% of the 112 patients undergoing POEM and 81.7% of the 109 patients undergoing LHM plus Dor’s fundoplication. Thus, POEM was non-inferior to LHM plus Dor’s fundoplication (P = 0.007 for non-inferiority). 44% of patients who underwent POEM and 29% of patients who underwent LHM plus Dor’s fundoplication had reflux oesophagitis at the 2-year follow-up.

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  1. Werner, Y. B. et al. Endoscopic or surgical myotomy in patients with idiopathic achalasia. N. Engl. J. Med. 381, 2219–2229 (2019)

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Correspondence to Jordan Hindson.

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Hindson, J. Endoscopic myotomy non-inferior to surgical myotomy for idiopathic achalasia. Nat Rev Gastroenterol Hepatol 17, 66 (2020). https://doi.org/10.1038/s41575-020-0263-2

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