Has the introduction of laparoscopic Heller myotomy altered the treatment paradigm of achalasia? DISCUSSION (Part 1)

Botulinum toxin We sought to determine the impact of the introduction of minimally invasive Heller myotomy for achalasia on the treatment patterns for this disease. An assessment of the local referral patterns has demonstrated that our own institution’s increasing experience in minimally invasive myotomy coincided with a reduction in the percentage of patients with previous endoscopic therapy. Although not reaching statistical significance, we found that the proportion of patients undergoing previous therapy was highest in the first 10 patients (70%) compared with subsequent patients (39%).We believe this is mainly due to a shift in thetreatment paradigm employed by the gastroenterologist in our group (SM), from whom the majority of our referrals originated. As our experience with laparoscopic Heller myotomy grew, patients who were referred for confirmation and management of their achalasia underwent operation without further endoscopic procedures, representing a change in management. This did not affect thetreatment patients received before referral to our centre. This finding is similar to that reported by Patti et al in which a gradual, nonsignificant increase in untreated patients being referred for myotomy was reported. buy asthma inhaler

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