{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:14:24Z","timestamp":1787066064970,"version":"build-2736575974"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2018,3,30]],"date-time":"2018-03-30T00:00:00Z","timestamp":1522368000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,6,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The aim of this national population-based cohort study was to compare rates of reintervention after surgical myotomy versus sequential pneumatic dilatation for the primary management of oesophageal achalasia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with oesophageal achalasia diagnosed between 2002 and 2012, and without an intervention in the preceding 5 years were identified from the Hospital Episode Statistics database. Patients were divided into two groups based on the primary treatment, and propensity score matching was used to compensate for differences in baseline characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Some 14 705 patients were diagnosed with oesophageal achalasia, of whom 7487 (50\u00b79 per cent) received interventional treatment: 1742 (23\u00b73 per cent) surgical myotomy, 4534 (60\u00b76 per cent) pneumatic dilatation and 1211 (16\u00b72 per cent) endoscopic botulinum toxin injection. As age increased, the proportion of patients receiving myotomy decreased and the proportion undergoing dilatation increased. Patients who underwent surgical myotomy were younger (mean age 44\u00b78 years versus 58\u00b75 years among those who had pneumatic dilatation; P &amp;lt; 0\u00b7001), a greater proportion had a Charlson co-morbidity index score of 0 (90\u00b71 versus 87\u00b77 per cent; P = 0\u00b7003) and they were more commonly men (55\u00b76 versus 51\u00b78 per cent; P = 0\u00b7020). Following propensity score matching, the safety of the two initial treatment approaches was equivalent, with no difference in incidence of oesophageal perforation (1\u00b73 and 1\u00b74 per cent after myotomy and dilatation respectively; P = 0\u00b7750). However, dilatation was associated with increased need for reintervention (59\u00b76 versus 13\u00b78 per cent; P &amp;lt; 0\u00b7001) and frequency of reinterventions (mean 0\u00b734 versus 0\u00b706 per year; P &amp;lt; 0\u00b7001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Surgical myotomy was associated with a lower rate of reintervention and could be offered as primary treatment in patients with oesophageal achalasia who are fit for surgery. For those unfit for surgery, pneumatic dilatation may provide symptomatic relief with approximately 60 per cent of patients requiring reintervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/bjs.10805","type":"journal-article","created":{"date-parts":[[2018,3,31]],"date-time":"2018-03-31T02:18:36Z","timestamp":1522462716000},"page":"1028-1035","source":"Crossref","is-referenced-by-count":18,"title":["Population-based cohort study of surgical myotomy and pneumatic dilatation as primary interventions for oesophageal achalasia"],"prefix":"10.1093","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8650-2017","authenticated-orcid":false,"given":"S R","family":"Markar","sequence":"first","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H","family":"Mackenzie","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Askari","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London, London, UK"},{"name":"St Mark's Hospital and Academic Institute, Harrow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O","family":"Faiz","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London, London, UK"},{"name":"St Mark's Hospital and Academic Institute, Harrow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Hoare","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"Zaninotto","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G B","family":"Hanna","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,3,30]]},"reference":[{"key":"2021020616593733200_bjs10805-bib-0001","doi-asserted-by":"crossref","first-page":"e256","DOI":"10.1111\/j.1365-2982.2010.01511.x","article-title":"Achalasia: incidence, prevalence and survival. 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