Endoscopic pneumatic dilation versus botulinum toxin injection in the management of primary achalasia

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Analysis 1.1

Comparison 1 Pneumatic Dilation versus Botulinum Toxin Injection, Outcome 1 Initial remission.

Analysis 1.2

Comparison 1 Pneumatic Dilation versus Botulinum Toxin Injection, Outcome 2 Mean oesophageal pressure within first four weeks.

Analysis 1.3

Comparison 1 Pneumatic Dilation versus Botulinum Toxin Injection, Outcome 3 Remission at six months.

Analysis 1.4

Comparison 1 Pneumatic Dilation versus Botulinum Toxin Injection, Outcome 4 Remission at twelve months.

Table 1. Studies meeting selection criteria but excluded from the meta‐analysis

Study	methods	Remission 1 month	Remission 6 months	Remission 12 months	Mean LOS pressure	Complications
Annese 1996	8 participants 100U BTX and 8 participants PD. PD: day 1 ‐ Rigiflex 30mm. Day 2 and 3 ‐ 35mm balloon BTX relapsers retreated.	PD 8/8 BTX 8/8	PD 8/8 BTX 6/8	PD 8/8 BTX 1/8	PD ‐72% BTX ‐44%	none
Muehldorfer 1999	12 participants 80 Units BTX and 12 PD 40mm day 1 & 3. BTX repeated at 1 week in 4 non responders.	PD 10/12 BTX 9/12	PD 9/12 BTX 6/12	PD 8/12 BTX 3/12	PD ‐50% BTX ‐44%	none

Table 1. Studies meeting selection criteria but excluded from the meta‐analysis

Comparison 1. Pneumatic Dilation versus Botulinum Toxin Injection

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Initial remission Show forest plot	4	132	Risk Ratio (M‐H, Fixed, 95% CI)	1.15 [0.95, 1.38]

2 Mean oesophageal pressure within first four weeks Show forest plot	3	90	Mean Difference (IV, Fixed, 95% CI)	‐0.77 [‐2.44, 0.91]

3 Remission at six months Show forest plot	2	56	Risk Ratio (M‐H, Fixed, 95% CI)	2.90 [1.48, 5.67]

4 Remission at twelve months Show forest plot	3	90	Risk Ratio (M‐H, Fixed, 95% CI)	2.67 [1.58, 4.52]

Comparison 1. Pneumatic Dilation versus Botulinum Toxin Injection