Comparison of peroral endoscopic myotomy and endoscopic balloon dilation for primary treatment of pediatric achalasia

Tan, Yuyong; Zhu, Hongyi; Li, Chenjie; Chu, Yi; Huo, Jirong; Liu, Deliang

doi:10.1016/j.jpedsurg.2016.06.008

Cited by 42 publications

(23 citation statements)

References 22 publications

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“…Operative time was shorter in the POEM group (70). Tan et al (71) compared prospectively a cohort of patients with PD (9) and POEM (12) and found no complications and a clinical response of 33.3% vs 100% after 36 months of follow-up.…”

Section: Pediatric Patientsmentioning

confidence: 99%

Efficacy of peroral endoscopic myotomy compared with other invasive treatment options for the different esophageal motor disorders

et al. 2017

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Short-term outcomes are similar to laparoscopic Heller myotomy (LHM) and pneumatic endoscopic dilation (PD) (clinical success > 90%) for achalasia subtypes I and II. Mid-term outcomes are comparable to LHM and overcome the results obtained after PD (> 90% vs ~50%). With regard to type III achalasia, POEM efficacy is 98% compared to 80.8% for LHM and the PD success remains at 40%. With regard to spastic esophageal disorders (SED), POEM has an effectiveness of 88% and 70% for distal esophageal spasm (DES) and jackhammer esophagus (JE) respectively. A response of 95% in patients with sigmoid esophagus has been reported. POEM has been performed in pediatric and elderly populations and has obtained a higher efficacy than PD in pediatric series (100% vs 33%) without greater adverse events. Previous treatments do not seem to hinder POEM results with excellent response rates, including 97% in post LHM and 100% in a re-POEM series. Final considerations: POEM has shown excellent short and mid-term results for all subtypes of achalasia but long-term results are not yet available. The promising results in SED may make POEM the first-line treatment for SED. A high-safety profile and efficacy have been shown in elderly and pediatric populations. Previous treatments do not seem to diminish the success rate of POEM. Core tip: POEM has emerged as an efficient treatment option for all subtypes of achalasia and other scenarios (including previous treatments and elderly and pediatric populations). Short and mid-term results are comparable to LHM and are better than PD data. The clinical response rate of DES and JE may make POEM the first-line treatment for SED.

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Section: Pediatric Patientsmentioning

confidence: 99%

Efficacy of peroral endoscopic myotomy compared with other invasive treatment options for the different esophageal motor disorders

et al. 2017

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“…In POEM, the exact length of esophageal hypercontractility and EGJ outflow obstruction can be dissected in a tailored manner, thus making it ideal for type III achalasia, which involves both the EGJ and the esophageal body . Although POEM now represents one of the most advanced treatment methods for achalasia, only a limited number of studies based on small number of patients have compared the treatment outcomes of patients treated with either BD or POEM . No randomized trial has been conducted on comparing POEM with BD for each subtype achalasia; therefore, optimal treatment modalities for each of the three subtypes of achalasia are still under debate.…”

Section: Introductionmentioning

confidence: 99%

“…6 Although POEM now represents one of the most advanced treatment methods for achalasia, only a limited number of studies based on small number of patients have compared the treatment outcomes of patients treated with either BD or POEM. 8 No randomized trial has been conducted on comparing POEM with BD for each subtype achalasia; therefore, optimal treatment modalities for each of the three subtypes of achalasia are still under debate. Moreover, differences in prognosis and long-term outcomes between POEM and BD are also unclear.…”

Section: Introductionmentioning

confidence: 99%

Superior clinical outcomes of peroral endoscopic myotomy compared with balloon dilation in all achalasia subtypes

Kim

Jung

et al. 2019

J of Gastro and Hepatol

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Background and Aim Optimal treatment modalities for each of the three subtypes of achalasia are still under debate. Differences in prognosis and long‐term outcomes between peroral endoscopic myotomy (POEM) and balloon dilation (BD) are also unclear. We aimed to compare the treatment outcomes of BD and POEM in each subtype of achalasia by using information from the manometry database of a tertiary referral center in Korea. Methods Data from 5207 esophageal manometry procedures performed between 1989 and 2016 were analyzed. The medical records and results of esophagography and esophagogastroduodenoscopy were also reviewed. Results We identified 264 patients (116 men and 148 women) with diagnosis of achalasia during the study period. POEM and BD were carried out on 64 and 177 patients, respectively. There was a significant difference in the time to relapse between the POEM group and the BD group (P = 0.002). At the 24‐month follow‐up, the clinical success rates of POEM and BD were 91.8% and 68.0%, respectively. The hazard ratio of symptom return was 6.54 for BD compared with POEM (95% confidence interval 2.12–20.22, P = 0.001). After a follow‐up period of 24 months, the success rate of POEM was significantly higher than that of BD for all subtypes of achalasia. However, only that of types I and II was statistically significant (type 1: 92.0% vs 51.1%, P = 0.004; type 2: 92.3% vs 59.8%, P = 0.007; and type3: 91.7% vs 55.6%, P = 0.051). Conclusions Peroral endoscopic myotomy was more effective than BD in providing mid‐long‐term remission in patients with all manometric subtypes of achalasia.

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“…In a recent study, 12 pediatric patients underwent POEM and nine underwent EBD for the primary treatment of achalasia. 26 Although the success rate of POEM and EBD at 3, 6 and 12 months after primary treatment was comparable, the treatment success rate of POEM at 24 and 36 months after the procedure was higher than that of EBD, demonstrating that POEM has better intermediate and long-term efficacy than EBD. This may have attributed to the reason that the LES had not been sufficiently cut off during EBD, whereas the circular muscle, even some of the longitudinal muscle, could be clearly cut off using POEM.…”

Section: Pediatric Patientsmentioning

confidence: 82%

“…Similarly, little is known about the comparison between POEM and endoscopic balloon dilation (EBD). In a recent study, 12 pediatric patients underwent POEM and nine underwent EBD for the primary treatment of achalasia . Although the success rate of POEM and EBD at 3, 6 and 12 months after primary treatment was comparable, the treatment success rate of POEM at 24 and 36 months after the procedure was higher than that of EBD, demonstrating that POEM has better intermediate and long‐term efficacy than EBD.…”

Section: Special Achalasiamentioning

confidence: 99%

POEM for special patient cohorts: A review

Zhang

et al. 2017

J of Digest Diseases

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Peroral endoscopic myotomy (POEM) is a natural orifice, translumenal endoscopic surgical procedure that achieves endoscopic myotomy by conducting a submucosal tunnel as an operating space. It is conventionally performed in achalasia. Recently, several centers worldwide have reported the feasibility of this procedure not only in early achalasia but also in other particular patient cohorts. Possible indications for POEM include previously failed Heller myotomy, pneumatic balloon dilatation or POEM, sigmoid achalasia, pediatric patients, spastic esophagus disorders, Zenker's diverticulum and gastroparesis. However, its application in large numbers of special patient groups awaits knowledge of the long-term outcome and greater experience with POEM.

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Comparison of peroral endoscopic myotomy and endoscopic balloon dilation for primary treatment of pediatric achalasia

Cited by 42 publications

References 22 publications

Efficacy of peroral endoscopic myotomy compared with other invasive treatment options for the different esophageal motor disorders

Efficacy of peroral endoscopic myotomy compared with other invasive treatment options for the different esophageal motor disorders

Superior clinical outcomes of peroral endoscopic myotomy compared with balloon dilation in all achalasia subtypes

POEM for special patient cohorts: A review

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