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J Dig Dis. 2016 Apr;17(4):222-35. doi: 10.1111/1751-2980.12327.

High-resolution manometric subtypes as a predictive factor for the treatment of achalasia: A meta-analysis and systematic review.

Author information

1
Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University.
2
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University.
3
Department of Gastroenterology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong Province.
4
Department of Gastroenterology, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, Beijing, China.

Abstract

OBJECTIVE:

To assess manometric subtypes as predictive factors for the treatment efficacies of pneumatic balloon dilatation (PBD) and laparoscopic Heller myotomy (LHM) in patients with achalasia.

METHODS:

A systematic search of the Pubmed, Embase and Cochrane Library database was conducted to identify relevant publications on high-resolution manometric subtypes and different therapies for achalasia with predefined inclusion and exclusion criteria. Data on the success rates after PBD or LHM for different manometric subtypes were extracted. The pooled odds ratio (OR) and 95% confidence interval (CI) for different manometric subtypes were estimated using STATA 13.0.

RESULTS:

In all, nine studies met the inclusion criteria. A total of 298 patients having achalasia receiving PBD and 429 undergoing LHM were included in the meta-analysis. The pooled OR between the subtypes of achalasia after PBD or LHM showed that the best and worse treatment outcomes were found in patients with type II and III achalasia, respectively (type I vs type II after PBD: OR 0.16, 95% CI 0.08-0.36, P = 0.000; type I vs type III after PBD: OR 3.64, 95% CI 1.55-8.53, P = 0.003; type II vs type III after PBD: OR 27.18, 95% CI 9.08-81.35, P = 0.000; type I vs type II after LHM: OR 0.26, 95% CI 0.12-0.56, P = 0.001; type I vs type III after LHM: OR 1.89, 95% CI 0.80-4.50, P = 0.148; type II vs type III after LHM: OR 6.86, 95% CI 2.72-17.28, P = 0.000).

CONCLUSION:

Type II achalasia shows the best prognosis after PBD and LHM, while type III achalasia has the worst prognosis.

KEYWORDS:

Achalasia; Chicago classification; high-resolution manometry; laparoscopic Heller myotomy; pneumatic balloon dilation; treatment outcome

PMID:
26860986
DOI:
10.1111/1751-2980.12327
[Indexed for MEDLINE]

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