Short-term safety and efficacy of peroral endoscopic myotomy for the treatment of achalasia in children

Background Peroral endoscopic myotomy (POEM) has shown excellent results for the treatment of achalasia in adults, but studies for children are limited. The study was aimed to analyze outcomes of peroral endoscopic myotomy (POEM) in children and compared with those in adults in a large multi-center...

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Bibliographic Details
Published in:Journal of gastroenterology 2020-02, Vol.55 (2), p.159-168
Main Authors: Liu, Zuqiang, Wang, Yun, Fang, Ying, Huang, Ying, Yang, Hongbin, Ren, Xiaoxia, Xu, Meidong, Chen, Shiyao, Chen, Weifeng, Zhong, Yunshi, Zhang, Yiqun, Qin, Wenzheng, Hu, Jianwei, Cai, Mingyan, Yao, Liqing, Li, Quanlin, Zhou, Pinghong
Format: Article
Language:English
Subjects:
Abdominal Surgery
Achalasia
Analysis
Children
Children's furniture
Colorectal Surgery
Drug therapy
Endoscopy
Gastroenterology
Hepatology
Medicine
Medicine & Public Health
Mucosa
Original Article—Alimentary Tract
Pneumothorax
Rankings
Surgical Oncology
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Summary:Background Peroral endoscopic myotomy (POEM) has shown excellent results for the treatment of achalasia in adults, but studies for children are limited. The study was aimed to analyze outcomes of peroral endoscopic myotomy (POEM) in children and compared with those in adults in a large multi-center study. Methods Records of consecutive patients with achalasia who underwent POEM at three tertiary centers were reviewed. A total of 130 children were included in this study. The primary outcomes of perioperative outcomes and clinical follow-up data were analyzed. Results One child (0.8%) experienced technical failure. Five children (3.8%) had major adverse events, including one with pneumothorax requiring drainage, two with delayed mucosa barrier failure, one with readmission, and one with vital-sign instability. Both post-POEM Eckardt score and median LES pressure were significantly lower than their pre-POEM reference values in children (0.7 vs 7.4; 7.0 vs 27.1 mmHg; both P   0.05). Kaplan–Meier analysis showed that the risk of clinical failure was lower in children than adults (log-rank test, hazard ratio = 0.37, 95% confidence interval 0.15–0.91, P  = 0.023). Conclusions POEM can be safely performed in children with achalasia, and produce a better clinical response during long-term follow-up compared with that in adults.
ISSN:0944-1174
1435-5922
DOI:10.1007/s00535-019-01607-4