{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T11:13:00Z","timestamp":1787224380938,"version":"build-2736575974"},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"24","license":[{"start":{"date-parts":[[2022,6,17]],"date-time":"2022-06-17T00:00:00Z","timestamp":1655424000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>: Current guidelines recommend per-oral endoscopic myotomy (POEM) and laparoscopic Heller's myotomy (LHM) as first-line treatment of idiopathic achalasia, but the optimum choice between different endoscopic and surgical modalities remains inconclusive. We conducted a network meta-analysis to compare the efficacy of 8 treatments for idiopathic achalasia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>: Three major bibliographic databases were reviewed for enrollment of randomized controlled trials between January 2000 and June 2021. We included adults with idiopathic achalasia and compared two or more of eight interventions including botulinum toxin injection (BTI), pneumatic dilation (PD), BTI\u200a+\u200aPD, LHM without fundoplication, LHM followed with Dor or Toupet fundoplication, and POEM using either the anterior or posterior approach. Our focus was on clinical success rate, postsurgical acid reflux, and moderate-to-severe adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>: Twenty-four studies involved a total of 1987 participants for analysis. When compared with PD, POEM with anterior approach, POEM with posterior approach, LHM\u200a+\u200aToupet, and LHM\u200a+\u200aDor were all significantly superior to the other regimens in short-term efficacy, with POEM with anterior approach and LHM\u200a+\u200aDor showing better improvement in mid-term efficacy. BTI showed a significantly lower efficacy than PD in both periods. Regarding safety, only LHM without fundoplication was significantly associated with higher acid reflux than PD, while LHM\u200a+\u200aToupet, LHM without fundoplication, and LHM\u200a+\u200aDor showed a non-significant increase in moderate-to-severe adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>: For idiopathic achalasia, we suggest that POEM with an anterior or posterior approach and LHM with Dor or Toupet fundoplication be initially recommended. On the contrary, both LHM without fundoplication and BTI are not recommended as definitive therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/md.0000000000029441","type":"journal-article","created":{"date-parts":[[2022,6,17]],"date-time":"2022-06-17T09:07:10Z","timestamp":1655456830000},"page":"e29441","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":9,"title":["The comparisons of different therapeutic modalities for idiopathic achalasia"],"prefix":"10.1097","volume":"101","author":[{"given":"Sz-Iuan","family":"Shiu","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan"},{"name":"Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan"},{"name":"Evidence-based Practice and Policymaking Committee, Taichung Veterans General Hospital, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chung-Hsin","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Kang","family":"Tu","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan"},{"name":"Department of Medical Research, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan"},{"name":"Department of Dentistry, National Taiwan University Hospital and School of Dentistry, National Taiwan University, Taipei, Taiwan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chung-Wang","family":"Ko","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,6,17]]},"reference":[{"key":"R1-20250612","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1001\/jama.2015.2996","article-title":"Achalasia: a systematic review","volume":"313","author":"Pandolfino","year":"2015","journal-title":"JAMA"},{"key":"R2-20250612","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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