The following is a summary of “Comparison of Endoscopic Dilatation and Heller’s Myotomy for Treating Esophageal Achalasia in Children: A Multicenter Study,” published in the DECEMBER 2022 issue of Pediatrics by Nicolas, et al.

For a study, researchers sought to evaluate the effectiveness and side effects of the two primary achalasia therapies, surgical cardiomyotomy (Heller’s myotomy) and endoscopic dilatation.

They gathered information retroactively from 8 tertiary pediatric hospitals over an 11-year period on kids treated for achalasia. A therapy route was outlined as either doing Heller’s myotomy or performing 1-3 sessions of endoscopic dilatation over three months. Clinical improvement and the absence of the need for further therapy were the a priori criteria for treatment success.

There were 97 youngsters (median age, 12 years; 57% males). The overall follow-up length was 27 months, while the median time to diagnosis was 10.5 months. As the first course of therapy, 60 children had endoscopic dilatation, whereas 37 children underwent Heller’s myotomy. With a median survival without failure of 49 and 7 months, respectively, and no statistically significant difference in the frequency of complications (35.2% for Heller’s myotomy, 29.7% for endoscopy dilatation, P =.56), Heller’s myotomy was significantly more successful than endoscopy dilatation after adjusting for potentially confounding factors (hazard ratio, 3.93 [1.74; 8.88]; P =.001). Pneumatic and hydrostatic dilatation both had favorable results (hazard ratio: 1.35 [0.56; 3.23]; P =.50).

Heller’s myotomy was more effective than endoscopic dilatation, and the incidence of major consequences was not significantly different between the two procedures. As an alternative to Heller’s myotomy, peroral endoscopic myotomy might play a part in it.

Reference: jpeds.com/article/S0022-3476(22)00631-X/fulltext