Zuqiang Liu1, Yun Wang1, Ying Fang2, Ying Huang3, Hongbin Yang2, Xiaoxia Ren2, Meidong Xu1, Shiyao Chen1, Weifeng Chen1, Yunshi Zhong1, Yiqun Zhang1, Wenzheng Qin1, Jianwei Hu1, Mingyan Cai1, Liqing Yao1, Quanlin Li4, Pinghong Zhou5. 1. Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, People's Republic of China. 2. Department of Gastroenterology, The Children's Hospital of Xi'an City, Xi'an, China. 3. Department of Gastroenterology, Children's Hospital, Fudan University, Shanghai, China. 4. Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, People's Republic of China. li.quanlin@zs-hospital.sh.cn. 5. Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, People's Republic of China. zhou.pinghong@zs-hospital.sh.cn.
Abstract
BACKGROUND: Peroral endoscopic myotomy (POEM) has shown excellent results for the treatment of achalasia in adults, but studies for children are limited. The study was aimed to analyze outcomes of peroral endoscopic myotomy (POEM) in children and compared with those in adults in a large multi-center study. METHODS: Records of consecutive patients with achalasia who underwent POEM at three tertiary centers were reviewed. A total of 130 children were included in this study. The primary outcomes of perioperative outcomes and clinical follow-up data were analyzed. RESULTS: One child (0.8%) experienced technical failure. Five children (3.8%) had major adverse events, including one with pneumothorax requiring drainage, two with delayed mucosa barrier failure, one with readmission, and one with vital-sign instability. Both post-POEM Eckardt score and median LES pressure were significantly lower than their pre-POEM reference values in children (0.7 vs 7.4; 7.0 vs 27.1 mmHg; both P < 0.001). During a median follow-up time of 40 months, clinical reflux rate was 27.0% and clinical failure rates at 1, 3, and 5 years were 1.8%, 3.5%, and 4.4% for children. The technical failure, major adverse events, and postoperative clinical reflux were comparable between children and adults (all P > 0.05). Kaplan-Meier analysis showed that the risk of clinical failure was lower in children than adults (log-rank test, hazard ratio = 0.37, 95% confidence interval 0.15-0.91, P = 0.023). CONCLUSIONS: POEM can be safely performed in children with achalasia, and produce a better clinical response during long-term follow-up compared with that in adults.
BACKGROUND: Peroral endoscopic myotomy (POEM) has shown excellent results for the treatment of achalasia in adults, but studies for children are limited. The study was aimed to analyze outcomes of peroral endoscopic myotomy (POEM) in children and compared with those in adults in a large multi-center study. METHODS: Records of consecutive patients with achalasia who underwent POEM at three tertiary centers were reviewed. A total of 130 children were included in this study. The primary outcomes of perioperative outcomes and clinical follow-up data were analyzed. RESULTS: One child (0.8%) experienced technical failure. Five children (3.8%) had major adverse events, including one with pneumothorax requiring drainage, two with delayed mucosa barrier failure, one with readmission, and one with vital-sign instability. Both post-POEM Eckardt score and median LES pressure were significantly lower than their pre-POEM reference values in children (0.7 vs 7.4; 7.0 vs 27.1 mmHg; both P < 0.001). During a median follow-up time of 40 months, clinical reflux rate was 27.0% and clinical failure rates at 1, 3, and 5 years were 1.8%, 3.5%, and 4.4% for children. The technical failure, major adverse events, and postoperative clinical reflux were comparable between children and adults (all P > 0.05). Kaplan-Meier analysis showed that the risk of clinical failure was lower in children than adults (log-rank test, hazard ratio = 0.37, 95% confidence interval 0.15-0.91, P = 0.023). CONCLUSIONS: POEM can be safely performed in children with achalasia, and produce a better clinical response during long-term follow-up compared with that in adults.
Authors: M Hurwitz; R J Bahar; M E Ament; V Tolia; J Molleston; L J Reinstein; J M Walton; N Erhart; D Wasserman; C Justinich; J Vargas Journal: J Pediatr Gastroenterol Nutr Date: 2000-05 Impact factor: 2.839