Peroral Endoscopic Myotomy in Children With Achalasia: A Relatively Long-term Single-center Study

Background: Achalasia is a disease caused by neuromuscular dysfunction in the esophagogastric junction, with a relatively low incidence among children. Peroral endoscopic myotomy (POEM) is a new endoscopic procedure for the treatment of achalasia; however, it is rarely applied in children. Objectives: We aim to study the feasibility, safety, and effectiveness of POEM as a treatment for pediatric achalasia. Methods: A total of 21 pediatric patients (ages from 11 months to 18 years) diagnosed as having achalasia and treated with POEM from October of 2014 to October of 2016 in our hospital were included in our study. Indices such as clinical manifestations, nutritional status, Eckardt scores, high-resolution esophageal manometric measurements, gastroduodenoscopic findings, and upper gastroenterographic findings after treatment were respectively compared with those before treatment to analyze the effectiveness and safety of POEM. Results: All of the 21 children successfully received POEM. The patients were followed up for duration ranged from 3 to 24 months. Among these children, symptoms such as vomiting and dysphagia were significantly alleviated or resolved. The Eckardt scores had an average drop of 7 points after treatment compared with those before treatment. Postoperative gastroduodenoscopy and upper gastroenterography showed that the opening of the cardiac orifice was significantly enlarged and obstruction at the lower esophagus was significantly relieved. Conclusions: POEM is a mini-invasive technique and a promising new treatment for pediatric patients, making it worthy of further clinical research and application.