Does Heller's myotomy provide superior clinical outcome in comparison to botulinum toxin injection for treatment of achalasia? Best evidence topic (BET)

A best evidence topic was written according to a structured protocol. The question addressed was whether Heller's myotomy provides superior results in comparison to botulinum toxin injection (BoTx) for treatment of achalasia. A total of 119 papers were retrieved using the reported searches of which 5 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results were tabulated. The highest level of evidence was one multicenter randomised controlled trial. We concluded that Heller's myotomy is superior to botulinum toxin injection for treatment of achalasia in terms of short and long term clinical outcome. Botulinum toxin injection may be considered in older patients and in patients for whom an operation or pneumatic dilation entails a higher risk, or as a bridge when these more effective modalities are not immediately available. It has an excellent safety profile and can be performed as a day case procedure. (c) 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.