Local patterns of treatmentfor achalasia were assessed by reviewing prospectively collected data on all patients undergoing laparoscopic Heller myotomy at the McGill University Health Centre, Montreal, Quebec. The numbers and types of endoscopic intervention before surgery were recorded and compared between years. All laparoscopic Heller myotomies included a partial anterior 180° fundoplication and were performed or supervised by a single surgeon (GMF). asthma inhalers
To determine regionaltreatmentpatterns, all patients undergoing surgical myotomy from 1997 to 2002 in Quebec were identified from the Regie de l’assurance maladie du Quebec (RAMQ) billing administrative database. Index patients were identified by the billing code for surgical myotomy (transabdominal or thoracic esophagocardiomyotomy Heller). No distinction is made in the database between minimally invasive and open techniques. All patients undergoing Heller myotomy, based on this billing code, were assumed to have had a diagnosis of achalasia. Data obtained from the database included age, sex and date of myotomy. Previous endoscopic procedures for each index patient were noted from 1990 to 2002. No separate billing code exists for pneumatic dilation or Botulinum toxin injection. Therefore, for the purpose of the present study, all procedures with a code for esophagogastroduodenoscopy with intervention – dilation, injection or ligation – were assumed to be an endoscopictreatmentfor achalasia in patients who had a subsequent Heller myotomy. The date of previous or subsequent endoscopic procedures was recorded for each index patient. Patients were divided into two groups (prelaparoscopy and postlaparoscopy) defined by the approximate date when laparoscopic Heller myotomy became generally available in Quebec (January 1, 2000).