A decision analysis of the optimal initial approach to achalasia: laparoscopic Heller myotomy with partial fundoplication, thoracoscopic Heller myotomy, pneumatic dilatation, or botulinum toxin injection

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
David R UrbachL L Swanstrom

Abstract

In the absence of randomized controlled trials that directly compare all of the modern methods of managing achalasia, decision analysis may help determine the optimal treatment strategy. Four strategies for the initial management of achalasia were compared using the following decision model: (1) laparoscopic Heller myotomy and partial fundoplication; (2) pneumatic dilatation; (3) botulinum toxin injection; and (4) thoracoscopic Heller myotomy. Probabilities of clinical events and utilities of health states were estimated using review of the medical literature and patient interviews. A recursive decision tree (Markov model) was used to simulate all the important outcomes of each initial treatment option, allowing for complications, relapses over time, and transitions between strategies when appropriate. After 10 years, laparoscopic Heller myotomy with partial fundoplication was associated with the longest quality-adjusted survival (quality-adjusted life years [QALY] = 7.41). The difference between this strategy and either pneumatic dilatation or botulinum toxin injection was small. Thoracoscopic Heller myotomy was associated with the poorest quality-adjusted survival (QALY = 7.15). Pneumatic dilatation was the favored strategy w...Continue Reading

Citations

Apr 5, 2003·Journal of Laparoendoscopic & Advanced Surgical Techniques. Part a·Leonardo VillegasDaniel B Jones
Oct 17, 2003·World Journal of Gastroenterology : WJG·Ying-Sheng ChengKe-Zhong Shang
Sep 8, 2005·The American Journal of Gastroenterology·David R UrbachNicholas E Diamant
Oct 1, 2009·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Christopher W SnyderMary T Hawn
Oct 9, 2002·Annals of Surgery·Nicholas StylopoulosDavid W Rattner
Nov 26, 2003·The American Journal of Gastroenterology·Narendar Mohan GuptaVikas Gupta
Jul 13, 2005·Current Treatment Options in Gastroenterology·Joel E Richter
Dec 17, 2004·Clinical Neuropharmacology·Joseph JankovicMarkus Naumann
Feb 8, 2006·Annals of the Royal College of Surgeons of England·P J Lamb, S M Griffin
Oct 13, 2006·Current Opinion in Gastroenterology·Chandra Prakash, Ray E Clouse
Jun 24, 2011·Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia·Reza BagheriSadjad Noorshafiee
Nov 3, 2011·Surgical Endoscopy·Dimitrios StefanidisUNKNOWN Society of American Gastrointestinal and Endoscopic Surgeons
Dec 9, 2014·The Cochrane Database of Systematic Reviews·Jan E LeydenPadraic MacMathuna
Sep 18, 2009·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Garrett R RollGuilherme M Campos
Jul 9, 2011·Scandinavian Journal of Surgery : SJS : Official Organ for the Finnish Surgical Society and the Scandinavian Surgical Society·I GockelH Lang
Jul 10, 2003·Alimentary Pharmacology & Therapeutics·D GuiS C Magalini
Jul 5, 2007·Obesity Surgery·Robert W O'RourkeJohn G Hunter
May 25, 2012·Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus·S SpiliopoulosA Adam
Aug 20, 2005·Journal of Laparoendoscopic & Advanced Surgical Techniques. Part a·Jedediah A KaufmanBrant K Oelschlager
Jul 6, 2010·Gastroenterology·Dawn L Francis, David A Katzka

❮ Previous
Next ❯

Related Concepts

Related Feeds

Botulism

Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by the bacterium clostridium botulinum. Discover the latest research on botulism here.

Cardiomyopathy

Cardiomyopathy is a disease of the heart muscle, that can lead to muscular or electrical dysfunction of the heart. It is often an irreversible disease that is associated with a poor prognosis. There are different causes and classifications of cardiomyopathies. Here are the latest discoveries pertaining to this disease.

Botulism (ASM)

Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by the bacterium clostridium botulinum. Discover the latest research on botulism here.

Related Papers

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
Christopher W SnyderMary T Hawn
Gastrointestinal Endoscopy Clinics of North America
J E Richter
Digestive Diseases and Sciences
J Barry O'ConnorJoel E Richter
© 2021 Meta ULC. All rights reserved