Current management of pediatric achalasia

Tashiro, Jun; Petrosyan, Mikael; Kane, Timothy D.

doi:10.21037/tgh-20-215

Cited by 14 publications

(8 citation statements)

References 41 publications

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“…LHM for achalasia was first described in 1991 by Shimi et al 28 It was later introduced as a treatment for children by Holcomb et al 29 Since then, many authors have demonstrated that LHM is a safe and effective treatment even in pediatric age. [30][31][32][33][34] A recent survey among International Pediatric Endosurgical Group members outlined LHM as preferred technique in the treatment of pediatric EA. Results were consistent across the patient ages, and 94% of responders performed a concomitant partial gastric fundoplication.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Heller–Dor Is a Persistently Effective Treatment for Achalasia Even in Pediatric Patients: A 25-Year Experience at a Single Tertiary Center

et al. 2023

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Background Esophageal achalasia (EA) is a rare primary motility disorder in any age group, and particularly rare in the pediatric population, with a reported incidence of 0.18 per 100,000 children a year. EA in pediatric age is currently treated in the same way as in adults, but this approach is based on only a few studies on small case series. The aim of this retrospective study was to assess the long-term outcome of the laparoscopic Heller–Dor (LHD) procedure when performed in pediatric patients with EA at our university hospital. Materials and Methods We considered children and adolescents younger than 16 years old diagnosed with EA and treated with LHD between 1996 and 2022. Clinical data were prospectively collected in an ongoing database. Symptoms were recorded and their severity was calculated using the Eckardt score. Barium swallow, esophageal manometry (conventional or high-resolution), and endoscopy were performed before and after the surgical procedure. Results During the study period, 40 children with a median age of 14 years (interquartile range [IQR]: 11–15) underwent LHD. At a median follow-up of 10.5 years (IQR: 4.5–13.9), a good outcome was achieved in 36/40 patients (90%). Two of the four patients whose surgical procedure failed underwent complementary pneumatic dilations successfully, thus increasing the overall success rate to 95%. A previous endoscopic treatment (in five patients) did not affect the final outcome (p = 0.49). An intraoperative mucosal lesion was detected in only one patient (2.5%) and was repaired at the time without further consequences. During the follow-up, 22 patients underwent endoscopy, and 17 had pH monitoring as well: only 2 of these patients showed reflux esophagitis at endoscopy (one of them with abnormal findings on pH monitoring), amounting to a 9.1% rate of instrumentally confirmed postoperative reflux. Conclusion LHD is a safe and persistently effective treatment for EA in pediatric age, with a success rate comparable with what is usually obtained in adults, and better than what has been reported to date in the pediatric literature. Adding a fundoplication certainly helps ensure an optimal long-term control of any gastroesophageal reflux induced by the myotomy.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Heller–Dor Is a Persistently Effective Treatment for Achalasia Even in Pediatric Patients: A 25-Year Experience at a Single Tertiary Center

et al. 2023

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“…It was suggested that POEM should be performed as soon as possible, before causing distension of the esophagus, since the complete incision of the circular muscle seemed to be therapeutic in children (22). In a more recent study, 17/19 patients (89%) experienced sustained symptomatic relief after POEM (23). As concluded by a recent review (24), POEM is a promising technique in the pediatric population, with a high efficacy and low rate of adverse events.…”

Section: Discussionmentioning

confidence: 99%

New diagnostic and therapeutic procedures applied in pediatric esophageal achalasia in a pediatric tertiary center: A case series

Pop

Surdea-Blaga

et al. 2023

Exp Ther Med

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Achalasia is an esophageal motor disorder that is rare in children. While the condition is uncommon, it is especially difficult to diagnose in pediatric patients; however, the ability to form a diagnosis has progressed markedly with the advent of esophageal high-resolution manometry (HRM). The aim of the present study was to highlight particularities of the diagnosis, based on esophageal HRM, as well as the treatment of achalasia in children. The current study analyzed cases of achalasia from a single pediatric tertiary center, Clinical Emergency Hospital for Children (Cluj-Napoca, Romania). The clinical data and the results of the investigations of seven children with achalasia, the first children to be evaluated using esophageal HRM in the center, were reported. The patients were aged between 11 and 18 years. All the patients were newly diagnosed with achalasia, except for one. The duration of symptoms was between 4 months and 2 years in the newly diagnosed patients. All the patients were assessed with conventional esophageal manometry and/or esophageal HRM. A multidisciplinary team contributed to the diagnosis and the management of achalasia. A total of 4 children diagnosed with type II achalasia were treated with peroral endoscopic myotomy (POEM) and 3 of the patients were treated with pneumatic dilations. Overall, achalasia is a rare but challenging condition in children. A diagnosis starts with a clinical suspicion based on swallowing disorders and upper digestive endoscopy, and is confirmed by esophageal HRM. Therapy should be adapted to the type of achalasia, the age of the children and the severity. In the present study, a relatively recent treatment option, POEM, was applied in pediatric patients with minor immediate adverse events. The report of these cases adds to the limited experience of using HRM and POEM in children with achalasia.

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“…The gold standard of treatment in pediatric patients is laparoscopic Heller myotomy Botilium toxin injection is not recommended as there is no clear dose known for pediatric population [49]. Pneumatic dilation is not a good option for children as first line therapy, due to need for recurrent dilations [50]. In recent years, POEM has gained popularity and is Update on Achalasia Treatment DOI: http://dx.doi.org/10.5772/intechopen.108194 often preferred over traditional surgery.…”

Section: Special Considerations 41 Pediatric Populationmentioning

confidence: 99%

Perspective Chapter: Update on Achalasia Treatment

Marom¹,

Brodie²,

Mintz³

2023

Esophageal Surgery - Current Principles and Advances

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Achalasia is a primary motility disorder of the esophagus characterized by failure of relaxation of the lower esophageal sphincter (LES) and aperistalsis of the esophagus. There are 3 types of achalasia, diagnosed and differentiated according to the Chicago classification using high resolution manometry (HRM). The classic symptoms of achalasia as described by the Eckardt score are dysphagia, retrosternal pain, regurgitation and weight loss. This chapter will discuss the interesting evolution of achalasia in the modern era, the ways to diagnose achalasia, different sub-groups within achalasia patients population, treat it with either endoscopic or surgical manner, pre-operative and post-operative considerations and routine follow-up.

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Current management of pediatric achalasia

Cited by 14 publications

References 41 publications

Laparoscopic Heller–Dor Is a Persistently Effective Treatment for Achalasia Even in Pediatric Patients: A 25-Year Experience at a Single Tertiary Center

Laparoscopic Heller–Dor Is a Persistently Effective Treatment for Achalasia Even in Pediatric Patients: A 25-Year Experience at a Single Tertiary Center

New diagnostic and therapeutic procedures applied in pediatric esophageal achalasia in a pediatric tertiary center: A case series

Perspective Chapter: Update on Achalasia Treatment

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