Initial experience with peroral endoscopic myotomy for treatment of achalasia in children

Abstract

Background: Achalasia is a primary esophageal motility disorder characterized by aperistalsis of the esophagus and failed relaxation of the lower esophageal sphincter that presents rarely in childhood. The peroral endoscopic myotomy (POEM) procedure is an emerging treatment for achalasia in adults that has recently been introduced into pediatric surgical practice. Methods: This is a prospective case series of all children referred to Stanford University Lucile Packard Children's Hospital with manometry-confirmed achalasia who underwent a POEM procedure from 2014 to 2016. Results: We enrolled 10 subjects ranging in age from 7 to 17 years (M = 13.4). The mean pre- and 1-month post-procedure Eckardt scores were 7 (SD = 2.5) and 2.4 (SD = 2) (p < 0.001), respectively. The median procedure time for the entire cohort was 142 min (range 60–259 min) with ongoing improvement with increased experience (R 2 = 0.6, p = 0.008). There were no major adverse events. Conclusion: The POEM procedure can be successfully completed in children for the treatment of achalasia with demonstrated short-term post-operative improvement in symptoms. The adoption of advanced endoscopic techniques by pediatric surgeons may enable development of unique intraluminal approaches to congenital anomalies and other childhood diseases. Level of evidence: Treatment Study – Level IV