Peroral Endoscopic Myotomy for Pediatric Achalasia: A Retrospective Analysis of 21 Cases With a Minimum Follow-Up of 5 Years

Abstract

BackgroundPeroral endoscopic myotomy (POEM) has shown promising short-term safety and efficacy in pediatric patients, while long-term outcomes are largely unknown. This study aimed to assess the clinical effects of POEM for pediatric achalasia who had a follow-up of at least 5 years.MethodsPediatric patients from a single center who underwent a POEM between October 2011 and November 2016 were, respectively, collected and analyzed for long-term clinical outcomes. Patients were contacted to evaluate their current symptoms and encouraged repeat endoscopy and manometry. The clinical success, procedure-related parameters, adverse events, gastroesophageal reflux disease after POEM, and quality of life were evaluated.ResultsA total of twenty-four patients who underwent POEM in our center were studied, with a mean age of 14.42 ± 2.65. Two of the 24 patients (8.3%) had previous treatment. The mean of the procedure time was 58.67 ± 19.10 min, 8.3% (2/24) of patients experienced perioperative adverse events. The current symptom scores were obtained from 21 patients at a mean follow-up of 92.57 months, the remainder were lost to follow-up after a mean of 38 months. Eckardt scores were significantly improved from preoperative baseline (preoperative 7.67 ± 1.62 vs. current 0.86 ± 1.28, P < 0.001). Long-term overall success was achieved in 95.8% of patients and none required retreatment for symptoms. 12.5% of patients were suffered from clinical reflux. 76.2% of patients expressed satisfaction with POEM. No severe adverse events were observed during the operation and the 5-years follow-up.ConclusionPOEM resulted in successful symptomatic mitigation in a majority of pediatric patients after 5 years. A multi-center large-scale, prospective study is necessary for a confirmed conclusion.

Peroral Endoscopic Myotomy (POEM) in Children: A State of the Art Review

“…The results from literature on pediatric POEM are very promising but prospective studies are necessary to better assess long‐term outcomes and patient‐specific outcomes, including the consequences and management of longstanding gastroesophageal reflux disease following POEM (22). In a study that followed 21 pediatric patients for a minimum of 5 years, POEM had a success rate of 95.8% (Eckardt ≤ 3 or no need for reintervention) (32).…”

Per-oral endoscopic myotomy is safe and effective for pediatric patients with achalasia: A long-term follow-up study

“…Reflux esophagitis identified by EGD and assessed by the Los Angeles classification. A GerdQ score of GERD with a score of > 7 was defined as symptomatic reflux[ 11 , 13 ]. At median 5.7 years follow-up, 6 patients (6/34, 17.6%) were suffered from symptomatic reflux, with 2 patients (5.9%) showed reflux esophagitis (1 Los Angeles type A, 1 Los Angeles type B) on endoscopy and 4 patients (11.8%) were suffered from clinical reflux.…”

“…Standard tunnel and the length of myotomy were applied during POEM procedure in both groups. According to the previous studies, pediatric patients were all received standard tunnel and myotomy length[ 11 , 13 , 25 ]. POEM-related parameters such as length of tunnel, length of myotomy, types of myotomy and operation time were similar to those of adult patients.…”

“…Liu et al [ 13 ] showed only five children (3.8%) experienced major adverse events, which were resolved by conservative treatment[ 13 ]. Peng et al [ 11 ] found two children (8.3%) developed perioperative subcutaneous emphysema during the procedure and were spontaneously absorbed without any intervention[ 11 ]. Wood et al [ 25 ] showed that among 21 pediatric patients who received POEM, one had mucosa injury and one had pneumoperitoneum.…”

Use of an adapted bronchoscope for peroral endoscopic myotomy in a pediatric patient weighing less than 10 kg

“…Because children have a longer life expectancy, POEM, or laparoscopic-Heller myotomy, is an appropriate management for achalasia. 1 , 2 , 3 , 4 POEM is a promising endoscopic technique that is equally as effective and safe in pediatric patients as in adults; nevertheless, its implementation is limited to a few specialized centers. 3 , 4 , 5 …”