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Effect of peroral endoscopic myotomy vs pneumatic dilation on symptom severity and treatment outcomes among treatment-naive patients with achalasia: A randomized clinical trial

JAMA Jul 14, 2019

Ponds FA, et al. - Via a randomized clinical trial conducted at 6 hospitals in the Netherlands, Germany, Italy, Hong Kong, and the United States between September 2012 and July 2015, that involved 133 treatment-naive adult patients with achalasia, the researchers compared the influences of peroral endoscopic myotomy (POEM) with pneumatic dilation as initial treatment. No meaningful variation in 10 endpoints could be ascertained among groups. Also, no significant between-group variation in the median integrated relaxation pressure or median barium column height could be noted. In comparison to the pneumatic dilation group, reflux esophagitis occurred more frequently observed in the POEM group. Two serious adverse events, including 1 perforation, occurred following pneumatic dilation, whereas no serious adverse events were discovered following POEM. Therefore, at 2 years, treatment with POEM in comparison with pneumatic dilation led to a markedly greater treatment success rate amongst treatment-naive patients with achalasia. Moreover, for subjects with achalasia, these findings strengthened the consideration of POEM as an initial treatment option.
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