ReviewJournal of minimal access surgery
What to do when Heller's myotomy fails? Pneumatic dilatation, laparoscopic remyotomy or peroral endoscopic myotomy: A systematic review.
Review in Journal of minimal access surgery. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Redo Heller myotomy vs. POEM after failed Heller myotomy: a systematic review and meta-analysis.Surgical endoscopy · 2026Pooled it
- Pneumatic balloon dilatation versus laparoscopic Heller myotomy for achalasia: a failed attempt at meta-analysis.Surgical endoscopy · 2021Pooled it
- ACG Clinical Guidelines: Diagnosis and Management of Achalasia.The American journal of gastroenterology · 2020Guideline
- European guidelines on achalasia: United European Gastroenterology and European Society of Neurogastroenterology and Motility recommendations.United European gastroenterology journal · 2020Guideline
- Updated Systematic Review of Achalasia, with a Focus on POEM Therapy.Digestive diseases and sciences · 2020Pooled it
- Modern treatment for achalasia: endoscopic and surgical therapies.The British journal of surgery · 2026Review
- Imaging following endoscopic and surgical treatment of achalasia.Abdominal radiology (New York) · 2025Review
- Re-operation after prior esophagomyotomy.Journal of visualized surgery · 2024Article
- Achalasia.Nature reviews. Disease primers · 2022Review
- Laparoscopic Revisional Surgery After Failed Heller Myotomy for Esophageal Achalasia: Long-Term Outcome at a Single Tertiary Center.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2021Article
- First splenic rupture following an endoscopic esophageal myotomy: A case report.World journal of gastrointestinal endoscopy · 2021Article
- Peroral endoscopic myotomy: techniques and outcomes.Shanghai chest · 2021Article
- The Modern Age of POEM: the Past, Present and Future of Per-Oral Endoscopic Myotomy.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2021Review
- Endoscopic and Surgical Treatments for Achalasia: Who to Treat and How?Gastroenterology clinics of North America · 2020Review
- Peroral Endoscopic Myotomy as a Novel Treatment for Achalasia: Patient Selection and Perspectives.Clinical and experimental gastroenterology · 2020Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSurgical treatment of achalasia fails in 10%-20% of patients. The most frequent responsible cause is the performance of an incomplete myotomy at primary surgery. The treatment when the failure happens is not well defined. In this study, we review and evaluate the possible treatments to be carried out when surgical myotomy fails. We define its benefits and results, with the purpose of defining a therapeutic algorithm. MATERIALS AND
methodsThe systematic review was performed following the guidelines established by the Meta-analysis of Observational Studies in Epidemiology statement. We searched several electronic databases (MEDLINE, PubMED, EMBASE and Cochrane) from January 1991 to March 2017, with the keywords 'recurrent achalasia' 'POEM remyotomy', 'esophagomyotomy failure', 'Heller myotomy failure', 'myotomy failure', 'pneumatic balloon dilatation achalasia' and combinations between them, 'redo Heller', 'redo myotomy', 'reoperative Heller'.
resultsA total of 61 observational studies related to the treatment of patients with failure of Heller's myotomy were initially found. Finally, 37 articles were included in our study that provided data on 289 patients. Of these 289 patients, diagnosed of failed Heller's myotomy, 87 were treated with pneumatic dilatation (PD), 166 underwent surgical revision and finally 36 were treated with POEM. No randomised controlled trial was identified.
conclusionsThe three therapeutic options analysed in this review are effective and safe in the treatment of patients with achalasia with failure of surgical myotomy. The best results can be achieved following an algorithm similar to the one proposed here, where each procedure must be performed by well-experienced team in the selected modality.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.