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Per-oral endoscopic myotomy “reasonable” first-line treatment for idiopathic achalasia


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Journal
The Lancet Gastroenterology and Hepatology
Reuters Health - 21/10/2020 - Per-oral endoscopic myotomy (POEM) has comparable efficacy to laparoscopic Heller's myotomy (LHM) for the treatment of achalasia, and was ranked first in a network meta-analysis of randomized, controlled comparative trials that also included standard pneumatic dilation (PD). "Prior to our study all three endoscopic treatments - POEM, LHM and PD - were considered similarly effective based on poor quality evidence and small studies," Dr. Pradeep Mundre of Bradford Teaching Hospitals, UK told Reuters Health by email. "Evidence from our study suggests that PD performed worst, so ideally should not be preferred. But it can still be considered in some circumstances, depending on comorbidities, costs and patient preference." "There should be a greater focus on training in POEM in the future, as this is likely to be one of the main treatment options, along with LHM," he said. "Future innovation and research should explore combining anti-reflux ...


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