Pneumatic balloon dilation in pediatric achalasia: efficacy and factors predicting outcome at a single tertiary pediatric gastroenterology center

Nardo, Giovanni Di; Rossi, Paolo; Oliva, Salvatore; Aloi, Marina; Cozzi, Denis A.; Frediani, Simone; Redler, A; Mallardo, Saverio; Ferrari, Federica; Cucchiara, Salvatore

doi:10.1016/j.gie.2012.06.035

Cited by 57 publications

(35 citation statements)

References 37 publications

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“…PBD has a reported success between 70-90% in published case series. 13,14 Many experts prefer PBD as initial therapy for older children and adolescents with achalasia. The success rate after a single dilatation was only 67% in a recent study.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…Young patients do not respond well to PBD. 14 The results of intra-esophageal botulinum toxin injection are not satisfactory in adults as well as pediatric achalasia patients. About one half of the patients suffer from recurrent symptoms after several months.…”

Section: Discussionmentioning

confidence: 99%

Per Oral Endoscopic Myotomy in Children with Achalasia Cardia

Nabi

Ramchandani

Reddy

et al. 2016

J Neurogastroenterol Motil

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“…[15] Gockel et al proposed the necessity of myotomy increases with younger ages and supported the myotomy treatment as the first choice in children. [16] However, Khan et al reported that 12 children treated for achalasia with balloon dilatation all had relief of symptoms and weight gain.…”

Section: Discussionmentioning

confidence: 99%

Early myotomy and fundoplication in achalasia in childhood: a single-centre experience for 22 years

Erginel

Soysal

Keskin

et al. 2016

Acta Chirurgica Belgica

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Introduction The aim of this study was to review a single institution's experience with surgical interventions in children with achalasia and to determine treatment strategies for this rare disorder. Patients and methods This study is a retrospective analysis of 22 cases of childhood achalasia from 1991 to 2013. The patients were evaluated in terms of age, symptoms, interventions, intraoperative complications, and recurrent dysphagia. Results There were 13 boys and nine girls (7 months to 17 years old). The clinical symptoms were vomiting (68%), dysphagia (36%), wheezing (18%), coughing (13%), and weight-loss (13%). The mean duration of symptoms was 2.4 years (1 month to 6 years). A barium contrast X-ray study was performed in all of the patients. Oesophageal manometry was performed in eight patients. Six patients underwent multiple oesophageal dilatations (ED) as a first intervention. A Heller myotomy (HM) and fundoplication were performed in all the patients except two patients who recovered with dilatation. In the long term, one patient had a stricture due to the operation and had to undergo a reoperation. Of the Heller myotomy patients, one had a recurrent stricture that responded to dilatation. No other complications were present. All the patients are now asymptomatic. Conclusion Early diagnosis and prompt surgical treatment is important to prevent growth impairment in childhood achalasia cases. A Heller myotomy followed by a partial anti-reflux procedure is an effective treatment for achalasia in children. Based on our experience, it is superior to oesophageal dilatation therapy.

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“…The advantages of balloon dilatation include shorter length of stay, quicker recovery time, and decreased cost [13] . Pneumatic dilatation can be complicated by substernal pain, prolonged epigastric pain, esophageal perforation, aspiration pneumonia, and GERD [13,[16][17][18][19] . Multiple studies suggest that in older children, pneumatic dilation is effective and safe initial treatment for achalasia and may spare children with achalasia an operation [13,14,20] .…”

Section: Pneumatic Dilatationmentioning

confidence: 99%

“…For adult patients, Eckardt et al [21] reported recurrence rates in as high as 60% in patients who underwent a single pneumatic dilation. Recurrent symptoms in children following multiple dilatations may require surgical myotomy [17,18,22] .…”

Section: Pneumatic Dilatationmentioning

confidence: 99%

Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management

Franklin

Petrosyan

Kane

2014

WJGE

114

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Achalasia is an esophageal motility disorder characterized by failure of lower esophageal sphincter (LES) relaxation and is rare in children. The most common symptoms are vomiting, dysphagia, regurgitation, and weight loss. Definitive diagnosis is made with barium swallow study and esophageal manometry. In adults, endoscopic biopsy is recommended to exclude malignancy however; it is not as often indicated in children. Medical management often fails resulting in recurrent symptoms and the ultimate definitive treatment is surgical. Laparoscopic Heller myotomy with or without an anti-reflux procedure is the treatment of choice and has become standard of care for children with achalasia. Peroral endoscopic myotomy is a novel therapy utilized with increasing frequency for achalasia treatment in adults. More experience is needed to determine the safety, efficacy, and feasibility of peroral endoscopic myotomy in children.

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Pneumatic balloon dilation in pediatric achalasia: efficacy and factors predicting outcome at a single tertiary pediatric gastroenterology center

Cited by 57 publications

References 37 publications

Per Oral Endoscopic Myotomy in Children with Achalasia Cardia

Per Oral Endoscopic Myotomy in Children with Achalasia Cardia

Early myotomy and fundoplication in achalasia in childhood: a single-centre experience for 22 years

Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management

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