Per Oral Endoscopic Myotomy in Children with Achalasia Cardia

Nabi, Zaheer; Ramchandani, Mohan; Reddy, Duvvur Nageshwar; Darisetty, Santosh; Kotla, Rama; Kalapala, Rakesh; Chavan, Radhika

doi:10.5056/jnm15172

Cited by 48 publications

(29 citation statements)

References 30 publications

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“…No complications or special technical difficulties were reported (68). The study by Nabi et al (69) reported a 100% efficacy in 15 children during a one year follow-up, including radiological evidence.…”

Section: Pediatric Patientsmentioning

confidence: 93%

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: 93%

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

et al. 2017

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“…[15] Another study of 10 children included Eckhardt score, timed barium swallow, and high-resolution manometry one year after POEM and found significantly improved scores on these measures and complete symptom resolution. [23] The current lack of evidence supporting one treatment approach over another, combined with the rarity of achalasia in children, has led to wide variation in practice. [24] Well-designed multi-institutional studies are needed to improve treatment and prevent the adverse impact this disease has on a child's long-term quality of life.…”

Section: Esophageal Achalasiamentioning

confidence: 99%

Pediatric enteric neuropathies: diagnosis and current management

Westfal¹,

Goldstein

2017

Current Opinion in Pediatrics

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Purpose of Review Neurointestinal diseases are increasingly recognized as causes of significant gastrointestinal morbidity in children. This review highlights the most common pediatric enteric neuropathies and their diagnosis and management, emphasizing insights and discoveries from the most recent literature available. Recent Findings The embryologic and histopathologic causes of enteric neuropathies are varied. They range from congenital aganglionosis in Hirschsprung disease, to autoimmune-mediated loss of neuronal subtypes in esophageal achalasia and Chagas disease, to degenerative neuropathies in some cases of chronic intestinal pseudo-obstruction and gastroparesis. Increased awareness of the clinical presentation and diagnostic evaluation of these conditions is essential as it allows for earlier initiation of treatment and improved outcomes. Most current therapies, which include medical management, neurostimulation, and operative intervention, aim to minimize the symptoms caused by these conditions. The evidence base for many of these treatments in children is poor, and multi-institutional prospective studies are needed. An innovative therapy on the horizon involves using neuronal stem cell transplantation to treat the underlying pathology by replacing the missing or damaged neurons in these diseases. Summary While recent advances in basic and clinical neurogastroenterology have significantly improved our awareness and understanding of enteric neuropathies, the efficacy of current treatment approaches is limited. The development of novel therapies, including pharmacologic modulators of neurointestinal function, neurostimulation to enhance gut motility, and neuronal cell-based therapies, is essential to improve the long-term outcomes in children with these disorders.

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“…Maselli et al [58] described the first case of achalasia treated with POEM in a pediatric patient. Following this, other cases have been reported with high clinical success rate [59,60]; however, the procedure should be performed in expert hands.…”

Section: Interventionmentioning

confidence: 87%

Pediatric Endoscopy, Update 2020

et al. 2019

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Optimal management of pediatric endoscopy requires a multidisciplinary approach. In most hospitals, endoscopy in pediatric patients is performed by conventional gastroenterologists and only a few centers have specialized pediatric gastroenterologists. This is due to the fact that the number of pediatric gastroenterologists is limited and not all of them are experienced in endoscopic techniques. However, there are also some pediatric centers offering a high-quality and high-volume endoscopy service provided by very experienced pediatric gastroenterologists. Up to now, the literature on pediatric endoscopy is rather sparse. In this article, we describe current knowledge and practice of endoscopic procedures in pediatric patients, which should be relevant for both the adult and pediatric gastroenterologists.

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Per Oral Endoscopic Myotomy in Children with Achalasia Cardia

Cited by 48 publications

References 30 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

Pediatric enteric neuropathies: diagnosis and current management

Pediatric Endoscopy, Update 2020

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