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 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 < 0.001). During a median follow-up time of 40 months, clinical reflux rate was 27.0% and clinical failure rates at 1, 3, and 5 years were 1.8%, 3.5%, and 4.4% for children. The technical failure, major adverse events, and postoperative clinical reflux were comparable between children and adults (all 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.
['Liu|Zuqiang|Z|', 'Wang|Yun|Y|', 'Fang|Ying|Y|', 'Huang|Ying|Y|', 'Yang|Hongbin|H|', 'Ren|Xiaoxia|X|', 'Xu|Meidong|M|', 'Chen|Shiyao|S|', 'Chen|Weifeng|W|', 'Zhong|Yunshi|Y|', 'Zhang|Yiqun|Y|', 'Qin|Wenzheng|W|', 'Hu|Jianwei|J|', 'Cai|Mingyan|M|', 'Yao|Liqing|L|', 'Li|Quanlin|Q|', 'Zhou|Pinghong|P|']
D000293:Adolescent D000328:Adult D002648:Child D002675:Child, Preschool D004931:Esophageal Achalasia D049630:Esophageal Sphincter, Lower D004945:Esophagoscopy D005260:Female D005500:Follow-Up Studies D005764:Gastroesophageal Reflux D000074434:Heller Myotomy D006801:Humans D007223:Infant D007902:Length of Stay D008297:Male D057605:Natural Orifice Endoscopic Surgery D061646:Operative Time D012189:Retrospective Studies D017211:Treatment Failure
Achalasia Children POEM Outcome