International Journal of Gastrointestinal Intervention

Table. 2. Table 2

Summary of Landmark Randomized Clinical Trials in Achalasia Cardia Treatment by PD, LHM, and POEM

Study	Comparison	n	Success (%)	Follow-up	Adverse events (%)	GERD (%)	Drawback
Ponds et al (2019)⁷⁷	POEM	67	92	2 yr	0	41	Only allowed PD up to 35 mm
	vs	67	92		0	41	Considered re-dilatation as treatment failure
	PD (30 and 35 mm)	66	54 (P < 0.001)		3	7	Considered re-dilatation as treatment failure
Werner et al (2019)³⁹	POEM	112	83	2 yr	2.7	44	Length of myotomy was not standardized
	vs	112	83		2.7	44	POEM was not accompanied by any anti-reflux procedure where LHM was done with for fundoplication
	LHM + Dor fundoplication	109	81.7 (P = 0.007, non-inferiority)		7.3	29
Boeckxstaens et al (2011)¹⁰	PD	96	86 (2 yr)	43 mo	4	15	Follow-up short as effect may decrease over time
	vs	96	86 (2 yr)		4	15	Rigorous PD protocol over 2 yr - only 3rd series of PD within 2 yr of 2nd series considered as failure
	LHM + Dor Fundoplication	105	90 (2 yr) (P = 0.46)		12	23
Moonen et al (2016)¹¹	PD	96	82	5 yr	5	12	Re-dilatation required in 25% of PD patients - considered as treatment success
	vs	96	82		5	12
	LHM + Dor Fundoplication	105	84		11	34
Khashab et al (2020)⁵⁰	Anterior	73	90	1 yr	11	49	Single blinded
	vs	73	90		11	49	Abnormal acid exposure presented based on DeMeester score alone rather than percentage of time pH < 4
	Posterior POEM	77	89		9	42
Tan et al (2018)⁴⁸	Anterior	31	100	15.5 mo	12.9	26.7	Small number
	vs	31	100		12.9	26.7	Single centre
	Posterior POEM	32	100		3.1 (P = NS)	33.3 (pH study)	Short follow-up
	Mostly type II achalasia	32	100		3.1 (P = NS)	33.3 (pH study)
Ramchandani et al (2018)⁴⁹	Anterior	30	100% technical success both groups	6 mo	20	16	Short follow-up
	vs	30	100% technical success both groups		20	16	Pilot study - small number
	Posterior POEM	30	Similar reduction in LES pressure		3.3 (mucosal perforation)	37	Single centre
Richards et al (2004)³⁴	LHM	21	Postoperative LES pressure comparable	6 mo	None	47.6	Small number
	vs	21	Postoperative LES pressure comparable			47.6	Single centre
	LHM + Dor Fundoplication	22	Primary outcome			9 (P = 0.005)	Very short follow-up (6 mo)
	LHM + Dor Fundoplication	22	GERD			9 (P = 0.005)	Concern for incomplete myotomy
Rawlings et al (2012)³⁸	LHM + Dor	36	Similar symptoms relief of dysphagia	6–12 mo	5.5	42	Small number
	vs	36	Similar symptoms relief of dysphagia		5.5	42	Clinically significant GERD not measured
	LHM + Toupet fundoplication	24	Primary outcome GERD		8.3	21 (P = 0.152)	Clinically significant GERD not measured

PD, pneumatic dilatation; LHM, laparoscopic Heller’s myotomy; POEM, per-oral endoscopic myotomy; LES, lower esophageal sphincter; GERD, gastroesophageal reflux disease; NS, not significant.

Int J Gastrointest Interv 2020;9:53~61 https://doi.org/10.18528/ijgii200012