BACKGROUND: Peroral endoscopic myotomy (POEM) has been developed to provide a less-invasive myotomy for achalasia in adults but seldom has been used in pediatric patients. OBJECTIVE: To evaluate the feasibility, safety, and efficacy of POEM for pediatric patients with achalasia. DESIGN: Single-center, prospective study. SETTING: Academic medical center. PATIENTS: A total of 27 pediatric patients (mean age 13.8 years, range 6-17 years) with achalasia. INTERVENTIONS POEM MAIN OUTCOME MEASUREMENTS: The primary outcome was symptom relief during follow-up, defined as an Eckardt score of ≤3. Secondary outcomes were procedure-related adverse events, clinical reflux adverse events, and lower esophageal sphincter (LES) pressure on manometry before and after POEM. RESULTS: A total of 26 cases (96.3%) underwent successful POEM. A submucosal tunnelling attempt failed in 1 case because of serious inflammation and adhesion. No serious adverse events related to POEM were encountered. During a mean follow-up period of 24.6 months (range 15-38 months), treatment success was achieved in all patients (mean score before vs after treatment 8.3 vs 0.7; P < .001). Mean LES pressure also decreased from a mean of 31.6 mm Hg to 12.9 mm Hg after POEM (P < .001). Five patients developed clinical reflux adverse events (19.2%). LIMITATIONS: Single center and lack of some objective evaluations. CONCLUSION: This relatively long-term follow-up study adds to the evidence that POEM seems to be a promising new treatment for pediatric patients with achalasia, resulting in long-term symptom relief in all cases and without serious adverse events.
BACKGROUND: Peroral endoscopic myotomy (POEM) has been developed to provide a less-invasive myotomy for achalasia in adults but seldom has been used in pediatric patients. OBJECTIVE: To evaluate the feasibility, safety, and efficacy of POEM for pediatric patients with achalasia. DESIGN: Single-center, prospective study. SETTING: Academic medical center. PATIENTS: A total of 27 pediatric patients (mean age 13.8 years, range 6-17 years) with achalasia. INTERVENTIONS POEM MAIN OUTCOME MEASUREMENTS: The primary outcome was symptom relief during follow-up, defined as an Eckardt score of ≤3. Secondary outcomes were procedure-related adverse events, clinical reflux adverse events, and lower esophageal sphincter (LES) pressure on manometry before and after POEM. RESULTS: A total of 26 cases (96.3%) underwent successful POEM. A submucosal tunnelling attempt failed in 1 case because of serious inflammation and adhesion. No serious adverse events related to POEM were encountered. During a mean follow-up period of 24.6 months (range 15-38 months), treatment success was achieved in all patients (mean score before vs after treatment 8.3 vs 0.7; P < .001). Mean LES pressure also decreased from a mean of 31.6 mm Hg to 12.9 mm Hg after POEM (P < .001). Five patients developed clinical reflux adverse events (19.2%). LIMITATIONS: Single center and lack of some objective evaluations. CONCLUSION: This relatively long-term follow-up study adds to the evidence that POEM seems to be a promising new treatment for pediatric patients with achalasia, resulting in long-term symptom relief in all cases and without serious adverse events.
Authors: Oscar M Crespin; Louis W C Liu; Ambica Parmar; Timothy D Jackson; Jemila Hamid; Eran Shlomovitz; Allan Okrainec Journal: Surg Endosc Date: 2016-09-15 Impact factor: 4.584