Peroral endoscopic myotomy for treatment of achalasia in children and adolescents

BackgroundPeroral endoscopic myotomy (POEM) is a novel endoscopic technique for treatment of achalasia (AC) and has shown exciting results in adults. However, little is known about the safety and efficacy of POEM in children and adolescents. Herein we report our preliminary results of POEM for children and adolescents with AC.MethodsPOEM was performed in 9 consecutive patients with AC, whose age ranged from 10 to 17 years. After submucosal injection, a submucosal tunnel was created. Endoscopic myotomy of muscle bundles was then achieved under direct vision. The mucosal entry was closed by several clips. A validated clinical symptom score (Eckardt score), LES pressure, esophageal diameters and procedure-related complications were used to evaluate the outcomes.ResultsAll 9 patients underwent POEM successfully. Mean operation time was 56.7 minutes. Mean myotomy length was 8.3 cm. Among them, 4 patients underwent circular myotomy and 5 underwent full-thickness myotomy. Symptoms remitted in all of the cases during a follow-up of 3–30 months, Eckardt score was significantly reduced (preoperation vs postoperation, 7.0 ± 1.9 vs 0.8 ± 0.8, P < 0.05). Mean LES pressure decreased from 26.8 mm Hg to 9.1 mm Hg. Mean diameter of esophagus was dramatically decreased (preoperation vs postoperation, 50.6 ± 4.9 mm vs 29.6 ± 3.7 mm, P < 0.05). No serious complications related to POEM were encountered.ConclusionsOur initial experience suggests that POEM is a safe and effective method for treatment of achalasia in children and adolescents. Further evaluation and long-term data are mandatory for a more confirmed conclusion.