Background Though nitrates have been used in achalasia for a long time, the effectiveness of nitrates for achalasia is still controversial. Objectives To quantify short-term and long-term effects of nitrate therapy in patients with achalasia. Search strategy Trials were identified by searching the Cochrane Controlled Trials Register (Issue 4, 2001), MEDLINE (1966-2001), EMBASE (1980-2001), LILACS-Latin American and Caribbean health science literature (1982-2001) and CBM-Chinese Biomedical Database (1980-2000). Additionally, all references in the identified trials were checked for further relevant trials. Selection criteria All randomised controlled trials involving achalasia patients given any type of nitrates were included. Data collection amp; analysis Data were extracted By two independent observers based on the intention-to-treat principle. Odds ratios for the patients need to treat by invasive procedures, improvement of symptoms, LES pressure decrease, oesophageal emptying, and side effects were calculated. Numbers needed to treat (NNT) for avoiding invasive procedure, improvement of symptoms, oesophageal emptying, and numbers needed to harm (NNH) of side effects were also determined. Main results Two randomised cross-over studies were found, But no results are included. Due to the design of the studies and the method of reporting the results in the original paper it was not possible to extract the necessary information to examine any of the outcomes. Authors have been contacted to obtain this information. Reviewers’ conclusion We can conclude no implications for practice at this stage. Much more RCT data are needed to determine the effects of nitrates.
Objective To investigate the feasibility and safety of laparoscopic operation of gastric and gastroesophageal junction diseases. Methods Between May 2004 and June 2009, 59 patients with gastric and gastroesophageal diseases were treated laparoscopically. The operative methods and maneuvers were evaluated and perioperative interventions, complications and efficacy of patients were analyzed. Results All operations were successfully completed laparoscopically except for one patient with gastric cancer who required a conversion to open surgery. No short-term complications occurred in all cases. No port transplant metastasis occurred for the patients with gastric cancer after an average of 36 months (1-60 months) follow-up. One patient died of liver metastasis 12 months after operation. The 3-year survival rate was 93.3% (14/15). Conclusion Laparoscopic surgery of the gastric and gastroesophageal junction diseases is feasible and safe with minimal invasiveness, which is worth popularizing.
ObjectiveTo understand research progress of animal model of esophageal achalasia and discuss its pathogenesis briefly.Method Literatures about research progress of animal model of esophageal achalasia were reviewed. ResultsThe models of esophageal achalasia could been made in several ways, such as the obstruction model, the classic denervation model, and the increasingly popular gene model. These models were all based on the theory of the corresponding causes, with the processing of different factors, then completed the preparation of animal model. Conclusionsanimal model of esophageal achalasia goes through three stages: obstruction model, denervation model, and gene model. gene model of esophageal achalasia based on congenital theory could help us understand this disease better and make an ideal animal model, which could provide a reliable evidence for etiology study.
Objective To systematically evaluate efficacy and safety of endoscopic pneumatic dilation and endoscopic stent placement in treatment of achalasia. Methods Eligible studies comparing the pneumatic dilation and the stent placement in treatment of achalasia were identified by an electronic search of MedLine, Embase, ISI Web of Science, the Cochrane Database, China Biology Medicine and Wanfang databases from inception to December 2015. Two reviewers independently screened the literatures, extracted data, and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis. Results A total of 4 randomized controlled trials including 343 patients with achalasia (176 cases in the pneumatic dilation group, 167 cases in the stent placement group) were subjected to the final analysis. The results of meta-analysis showed that the postoperative short term symptom relief rate had no significant difference between the pneumatic dilation group and the stent placement group 〔RR=1.03, 95%CI (0.95, 1.12),P=0.53〕, the postoperative 2-year symptom relief rate of the stent placement group was significantly higher than that of the pneumatic dilation group 〔RR=0.77, 95%CI (0.64, 0.92),P=0.005〕, but the complications rate of the stent placement group was significantly higher as compared with the pneumatic dilation group 〔RR=0.52, 95%CI (0.40, 0.69),P<0.000 01〕 too. Conclusions Although this meta-analysis has some shortcomings, preliminary results show that short term effects of pneumatic dilation and stent placement in treatment of achalasia are effective, long term effect of stent placement in treatment of achalasia is better as compared with pneumatic dilation, but it’s complications rate is higher. So in clinical diagnosis and treatment, effect, risk, patient’s physical condition, and demand should be considered together; during treatment, we should pay attention to adverse reactions and prepare adequately in order to reducing complications. When complications occur, we should take timely symptomatic treatment.
Objective To compare effectiveness between laparoscopic Heller myotomy and peroral endoscopic myotomy (POEM) in treatment of achalasia of cardia (AC) in order to provide a basis for clinical choose. Method The literatures about the treatment of AC by laparoscopic Heller myotomy or POEM were retrieved from CNKI, Embase, PubMed databases, etc., and then the contents about curative effect and complications were summarized. Results The treatment models of AC included surgical treatment such as laparoscopic Heller myotomy and endoscopy such as POEM, but there was still lack of comparing data in these two treatment models, its selection remained controversial. There was a better short-term curative effect and slighter complications for POEM as compared with the laparoscopic Heller myotomy from the trend of published literatures. However, it’s long-term effects for these two treatment models were not clarified. Conclusions Both laparoscopic Heller myotomy and POEM are medicable for AC. POEM as a new treatment of AC shows some advantages of minimal invasion and exact efficacy, but it needs to be followed-up for a long-term. Treatment model for AC is chosen on basis of typing under endoscope, physical fitness, anatomy of easophagus, previous history, tolerance of surgery and other factors.
ObjectiveTo compare the clinical effect of laparoscopic Heller myotomy (LHM) combined with Dor fundoplication and peroral endoscopic myotomy (POEM) in treatment of patients with achalasia.MethodsThe clinical data of 67 patients with achalasia from January 2014 to December 2018 in the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. Among them, 19 patients received the LHM combined with Dor fundoplication (LHM group), 48 patients received the POEM (POEM group). The clinical efficacy and safety of the two groups were compared.ResultsThere were no significant differences in the baseline data such as the gender, age, course of disease, body mass index, preoperative Eckardt score, preoperative maximum diameter of esophagus, and previous treatment history between the two groups (P>0.05). There were no significant differences in the operation time, bleeding volume, the Eckardt points at 3 and 12 months after operation, the decrease degree of maximum diameter of esophagus, complications (except for gastroesophageal reflux, P=0.029), and recurrence rate between the two groups (P>0.05). The total hospitalization time, postoperative hospitalization time, and total hospitalization costs of the POEM group were lower than those of the LHM group (P<0.05).ConclusionsBoth LHM and POEM could effectively relieve clinical symptoms, short-term efficacy and safety of the two kinds of operations are similar. Postoperative recovery of POEM is fast and hospitalization cost is less, but incidence of gastroesophageal reflux is higher.