Endoscopic botulinum toxin injection versus pneumatic dilation in the management of achalasia / 中华消化内镜杂志

ABSTRACT

Objective To determine the effectiveness and safety of endoscopic botulinum toxin injection versus pneumatic dilation in treatment of achalasia.Methods A systematic review of all the relevant randomized controlled trials was performed according to international Cochrane Collaboration.Results Twelve trials involving 559 patients were included in the systematic review.Meta analysis showed(1)Pneumatic dilation was superior to botulinum toxin injection in short term symptom relief(83.21% VS 71.27%.P=0.0007);(2)It was also superior to botulinum toxin injection in long term symptom relief(54.59% vs 27.60%,P=0.005);(3)The recurrent rate is lower in botulinum toxin injection than in pneumatic dilation(55.66% vs 18.84%,P<0.0001);(4)There were more side-effects and complications in pneumatic dilation than in botulinum toxin injection(13.01% VS 1.35%,P=0.0008).Conclusion The limited current evidence showed that endoscopic botulinum toxin injection and pneumatic dilation are safe and effective in the short term treatment for achalasia.Pneumatic dilation is more effective than endoscopic botulinum toxin injection in the long term treatment for achalasia.