Long-term outcomes of peroral endoscopic myotomy for achalasia in pediatric patients: a prospective, single-center study

Chen, Weifeng; Li, Quan‐Lin; Zhou, Ping‐Hong; Yao, Ling; Xu, Mei‐Dong; Zhang, Yiqun; Zhong, Yun‐Shi; Ma, Lili; Qin, Wen‐Zheng; Hu, Jianwei; Cai, Mingjun; He, Meng‐Jiang; Zhao, Chunhe

doi:10.1016/j.gie.2014.06.035

Cited by 112 publications

(67 citation statements)

References 30 publications

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“…[19] Since then, a few small studies of POEM in children have been reported. [20][21][22] In a comparative study, Caldaro T. et al compared laparoscopic Heller's myotomy to POEM in 18 pediatric patients with achalasia. The authors concluded that the followup data indicated that laparoscopic Heller's myotomy and POEM were safe and effective in children.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted Heller’s myotomy for achalasia in children

Altokhais

Mandora

Alqahtani

et al. 2016

Computer Assisted Surgery

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Background: Achalasia is rare in children. Surgical options include open, laparoscopic and robotic approaches. However, Heller's myotomy remains the treatment of choice. This report describes our experience with robot-assisted Heller's myotomy in children and presents a review of the literature. Methods: Included in this study are children who underwent robot-assisted Heller's myotomy for esophageal achalasia via the Da Vinci surgical system between 2004 and 2015 at King Saud University Medical City, Riyadh, Saudi Arabia. The medical records of these patients were reviewed for demographic data, presenting symptoms, diagnostic modalities, operative procedures, complications, outcomes and follow-ups. Results: Six patients were identified. The age of the patients at surgery ranged between 2 and 12 years (mean 7.1 years). The most common presenting symptoms were dysphagia, vomiting and nocturnal cough. Contrast swallow and upper gastrointestinal endoscopy established a diagnosis of esophageal achalasia in all of the patients. Four patients underwent esophageal dilatation 2-5 times before the definitive procedure. All patients underwent successful robot-assisted Heller's myotomy with concomitant partial posterior fundoplication. The postoperative course was uneventful. Five patients had a complete resolution of the symptoms and one patient improved. The follow-up assessments have been consistent and have ranged from 0.5 to 11 years (mean 4.4 years). Conclusion: Robotic-assisted Heller's myotomy for esophageal achalasia in children is safe and effective and is a suitable alternative to open and laparoscopic approaches.

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Section: Discussionmentioning

confidence: 99%

Robot-assisted Heller’s myotomy for achalasia in children

Altokhais

Mandora

Alqahtani

et al. 2016

Computer Assisted Surgery

View full text Add to dashboard Cite

show abstract

“…22 Since these initial reports, few more studies have been published demonstrating the safety and efficacy of POEM for treatment of achalasia in children and adolescents. [23][24][25] We found POEM to be safe and effective in the pediatric age group, with no major adverse events. Complete resolution of symptoms along with significant fall in baseline LES pressure was noted in all the children after POEM (median follow-up 14 months).…”

Section: Discussionmentioning

confidence: 65%

Per Oral Endoscopic Myotomy in Children with Achalasia Cardia

Nabi

Ramchandani

Reddy

et al. 2016

J Neurogastroenterol Motil

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Background/AimsAchalasia cardia (AC) is a motility disorder, characterized by impaired lower esophageal sphincter relaxation and absence of esophageal peristalsis. AC is rare in children with unclear optimum management strategies. Per oral endoscopic myotomy (POEM) is a novel technique for management of achalasia with encouraging results in adult patients. The efficacy and safety of POEM is not known for pediatric AC. The aim of our study was to evaluate the safety and efficacy of POEM in children with achalasia cardia MethodsThe data of all children (< 18 years) who underwent POEM at our center was retrospectively analysed. Symptoms were analysed using a validated score (Eckardt score) at regular predefined intervals. Objective parameters including high-resolution manometry, timed barium swallow and esophagogastroduodenoscopy were assessed before the procedure and at 1-year follow-up. Clinical success was defined as an Eckardt score ≤ 3. ResultsA total of 15 children underwent POEM during the specified period. Ten out of 15 (10/15) completed 1-year follow-up. Median operative time was 100 (38-240) minutes. Mean pre and post procedure LES pressure were 36.64 ± 11.08 mmHg and 15.65 ± 5.73 mmHg, respectively (P = 0.001). Mean Eckardt score before and after the POEM was 7.32 ± 1.42 and 1.74 ± 0.67, respectively (P = 0.001). Mean percentage improvement in barium emptying at 5 minutes was 63.70 ± 4.46%. All children had complete resolution of symptoms at 1 year. Median weight gain of children at 1 year was 0.65 kg (range, 0.0-4.6). Conclusions

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“…However, 5 patients (19.2%) had mucosal injury or perforations. The authors attributed the high adverse event rate to technical difficulties, namely narrow lumen and fragile mucosa (16). Another study in India with 15 paediatric patients again reported 100% clinical response rate and 6.7% mucosal injury rate (17).…”

Section: Extreme Of Agementioning

confidence: 99%