{'fraction_non_alphanumeric': 0.020629190304280558, 'fraction_numerical': 0.006704486848891181, 'mean_word_length': 5.783216783216783, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Is laparoscopic Heller myotomy superior to pneumatic dilation to treat achalasia?

Achalasia is a primary esophageal motility disorder that is characterized by the inability of the lower esophageal sphincter to relax and by absence of esophageal body peristalsis, causing dysphagia, chest pain, and regurgitation of undigested food. The goal of treatment is to eliminate dysphagia by opening the lower esophageal sphincter, while preventing gastroesophageal reflux. The currently available treatment options include injection of botulinum toxin at the esophagogastric junction, endoscopic pneumatic dilation, and laparoscopic Heller myotomy (LHM); all therapeutic approaches are palliative and centered on relief of esophageal outlet obstruction. With the widespread acceptance of minimally invasive surgical approaches to diseases of the upper abdomen, LHM combined with a partial antireflux procedure has been most commonly performed and is considered by many to be superior to pneumatic dilation. Although numerous studies have been conducted to compare LHM with pneumatic dilation, publication bias and heterogeneity in technique coupled with the relative rarity of achalasia have led to inadequately powered studies and confusion among providers regarding the optimal approach. Boeckxstaens et al1 performed a multicenter, randomized controlled trial involving 14 hospitals in 5 European countries to compare the 2 treatment options, endoscopic pneumatic dilation and LHM combined with Dor fundoplication. Eligible subjects included adult patients with a new diagnosis of achalasia and an Eckardt symptom score greater than 3. The Eckardt score is the sum of the symptom scores for dysphagia, regurgitation, and chest pain (0 [absence of symptoms] to 3 [severe symptoms]) and weight loss (0 [no loss] to 3 [ 10-kg loss]).2 Patients who had severe comorbidities, previous treatment of achalasia, previous esophageal or gastric surgery,