Outcome of peroral endoscopic myotomy in children with achalasia

Surg Endosc. 2019 Nov;33(11):3656-3664. doi: 10.1007/s00464-018-06654-1. Epub 2019 Jan 22.

Abstract

Background and aims: Achalasia cardia is rare in children and optimum endoscopic management options are not well known. Peroral endoscopic myotomy (POEM) is a novel treatment modality for achalasia with excellent results in adult patients. The long-term outcomes of POEM are not well known in children. In this study, we aim to evaluate the outcome of POEM in children with idiopathic achalasia.

Methods: We analyzed the data of children (≤ 18 years) diagnosed with achalasia from September 2013 to January 2018. Technical success, clinical success, and adverse events were assessed. Post-POEM, gastroesophageal reflux (GER) was assessed with 24-h pH-impedance study and esophagogastroduodenoscopy.

Results: A total of 44 children (boys-23, girls-21) with mean age of 14.5 ± 3.41 years (4-18) were diagnosed with achalasia during the study period. Of these, 43 children underwent POEM. The subtypes of achalasia according to Chicago classification were type I-11, type II-29, type III-2, and unclassified-2. Eighteen children (40.9%) had history of prior treatment. POEM was successfully performed in 43 children (technical success-97.72%). Intra-operative adverse events occurred in 11 (25.6%) children including retroperitoneal CO2 (7), capnoperitoneum (3), and mucosal injury (1). Clinical success at 1, 2, 3, and 4 years' follow-up was 92.8%, 94.4%, 92.3%, and 83.3%, respectively. Erosive esophagitis was detected in 55% (11/20) children. On 24-h pH study, GER was detected in 53.8% (7/13) children.

Conclusion: POEM is a safe, effective, and durable treatment for achalasia in children. However, GER is a potential concern and should be evaluated in prospective studies before adopting POEM for the management of achalasia in children.

Keywords: Achalasia; Child; Endoscopy; Myotomy.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Esophageal Achalasia / surgery*
  • Esophagoscopy / methods*
  • Female
  • Heller Myotomy / methods*
  • Humans
  • Male
  • Mouth
  • Natural Orifice Endoscopic Surgery / methods*
  • Retrospective Studies
  • Treatment Outcome