Has the introduction of laparoscopic Heller myotomy altered the treatment paradigm of achalasia? RESULTS (Part 2)

Survey of gastroenterologists
A total of 147 gastroenterologists were listed in the Quebec College des Medecins directory. Response rate after the second mailing was 41% (60 of 147). Although 90% of respondents agreed that surgical myotomy represented the most effective long-termtreatment for achalasia (Figure 3A), only 37% would refer a newly diagnosed patient for immediate Heller myotomy (Figure 3B).

Of the 55% choosing pneumatic dilation as first-line therapy, 58% would refer the patient for surgical opinion after a single failed dilation, while 8% would never refer to surgery (Figure 3C). In those who would not refer for immediate surgery, 73% cited patient comorbidity and 21% cited surgical trauma/morbidity as the reason for alternatetreatment (Figure 3D). Among physicians whotreat more than four new patients with achalasia per year, five of eight would refer for immediate surgical myotomy as the first-line therapy. buy flovent inhaler

Figure_3

 

Figure 3) Responses from a questionnaire investigating the prevailing biases in the treatment of achalasia sent to all Quebec gastroenterologists. A Referring physicians’ perception of the most effective long-term treatment for achalasia. The vast majority considered surgical myotomy to be the most effective treatment. B First-line treatment for achalasia according to responses from a questionnaire to all Quebec gastroenterologists. C Referring physician-based threshold for referral of an achalasia patient for surgical myotomy (number of endoscopic interventions to be attempted before to surgical referral). D Reasons for nonreferral for surgical myotomy. The majority of responding gastroenterologists deemed the surgical procedure too morbid for a given patient’s physiological state. Botox Botulinum toxin; Lap Laparoscopic

 

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