A single center 26-year experience with treatment of esophageal achalasia: is there an optimal method?

Pastor, Aimee C.; Mills, Jessica; Marcon, Margaret; Himidan, Sharifa; Kim, Peter C.W.

doi:10.1016/j.jpedsurg.2008.10.117

Cited by 59 publications

(61 citation statements)

References 20 publications

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“…Average weight loss was 9.9 kg requiring supplemental nutrition. Mean duration of symptoms prior to surgical treatment was 2.8 years, which was consistent with multiple studies [16,[26][27][28][29][30][31] . Upper endoscopy in our patients commonly showed a dilated esophagus with retained food products.…”

Section: Surgicalsupporting

confidence: 86%

“…POEM is performed utilizing flexible endoscopy, mucosal incision and dissection of a submucosal tunnel distally in the esophageal wall to approach the esophagogastric junction. A 2-3 cm longitudinal incision in the inner circular muscle approximately 4 cm from the LES, will produce similar results to the literature, there was 0%-26% recurrence rate of dysphagia after LHM with or without an anti-reflux procedure (Table 3) [16,24,[26][27][28][29][30]33] . It is unclear if recurrent dysphagia is secondary to the nature of disease or failure of surgical treatment.…”

Section: Surgicalsupporting

confidence: 71%

“…The advantages of balloon dilatation include shorter length of stay, quicker recovery time, and decreased cost [13] . Pneumatic dilatation can be complicated by substernal pain, prolonged epigastric pain, esophageal perforation, aspiration pneumonia, and GERD [13,[16][17][18][19] . Multiple studies suggest that in older children, pneumatic dilation is effective and safe initial treatment for achalasia and may spare children with achalasia an operation [13,14,20] .…”

Section: Pneumatic Dilatationmentioning

confidence: 99%

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Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management

Franklin

Petrosyan

Kane

2014

WJGE

111

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Achalasia is an esophageal motility disorder characterized by failure of lower esophageal sphincter (LES) relaxation and is rare in children. The most common symptoms are vomiting, dysphagia, regurgitation, and weight loss. Definitive diagnosis is made with barium swallow study and esophageal manometry. In adults, endoscopic biopsy is recommended to exclude malignancy however; it is not as often indicated in children. Medical management often fails resulting in recurrent symptoms and the ultimate definitive treatment is surgical. Laparoscopic Heller myotomy with or without an anti-reflux procedure is the treatment of choice and has become standard of care for children with achalasia. Peroral endoscopic myotomy is a novel therapy utilized with increasing frequency for achalasia treatment in adults. More experience is needed to determine the safety, efficacy, and feasibility of peroral endoscopic myotomy in children.

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Section: Surgicalsupporting

confidence: 86%

Section: Surgicalsupporting

confidence: 71%

Section: Pneumatic Dilatationmentioning

confidence: 99%

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Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management

Franklin

Petrosyan

Kane

2014

WJGE

111

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“…[12] Despite the lack of a definite conclusion, advances and refinements in laparoscopy in pediatrics, a low rate of complications, a high rate of success and faster recovery have shifted the treatment preference toward laparoscopic Heller's myotomy. [13] Most studies in children have supported using surgical Heller's myotomy for long-term outcomes since the introduction of minimal surgical techniques. [5,[14][15][16][17] Recently, endoscopic peroral esophageal myotomy (POEM) has also been described.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted Heller’s myotomy for achalasia in children

Altokhais

Mandora

Alqahtani

et al. 2016

Computer Assisted Surgery

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Background: Achalasia is rare in children. Surgical options include open, laparoscopic and robotic approaches. However, Heller's myotomy remains the treatment of choice. This report describes our experience with robot-assisted Heller's myotomy in children and presents a review of the literature. Methods: Included in this study are children who underwent robot-assisted Heller's myotomy for esophageal achalasia via the Da Vinci surgical system between 2004 and 2015 at King Saud University Medical City, Riyadh, Saudi Arabia. The medical records of these patients were reviewed for demographic data, presenting symptoms, diagnostic modalities, operative procedures, complications, outcomes and follow-ups. Results: Six patients were identified. The age of the patients at surgery ranged between 2 and 12 years (mean 7.1 years). The most common presenting symptoms were dysphagia, vomiting and nocturnal cough. Contrast swallow and upper gastrointestinal endoscopy established a diagnosis of esophageal achalasia in all of the patients. Four patients underwent esophageal dilatation 2-5 times before the definitive procedure. All patients underwent successful robot-assisted Heller's myotomy with concomitant partial posterior fundoplication. The postoperative course was uneventful. Five patients had a complete resolution of the symptoms and one patient improved. The follow-up assessments have been consistent and have ranged from 0.5 to 11 years (mean 4.4 years). Conclusion: Robotic-assisted Heller's myotomy for esophageal achalasia in children is safe and effective and is a suitable alternative to open and laparoscopic approaches.

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“…[14][15][16] On the other hand, many authors prefer to omit anti-reflux procedure in these patients. 17,18 Clinically significant GERD is reported to occur in 15% to 20% of children following surgery. 19 Moreover, a relative esophageal obstruction may be created from the fundal wrap in the face of significantly impaired esophageal motility.…”

Section: Figure-2: Contrast X-ray Barium Meal Upper Git Showing Mega-mentioning

confidence: 99%

Achalasia Cardia in a 6-Month-Old Boy: Case Report and Review of Literature

Choudhury

Begum

2016

Birdem Med J

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Achalasia cardia is commonly seen in adult population. It is extremely rare in infants and seldom found in children. Diagnosis of the disease is difficult in children particularly in small infants because the typical symptoms are missing and hardly there are any sign.High index of suspicion should be exercised to bring it among the differentials. We have described a 6-month-old boy with achalasia cardia and reviewed recent literatures to elucidate current scenario.Birdem Med J 2016; 6(1): 46-49

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A single center 26-year experience with treatment of esophageal achalasia: is there an optimal method?

Cited by 59 publications

References 20 publications

Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management

Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management

Robot-assisted Heller’s myotomy for achalasia in children

Achalasia Cardia in a 6-Month-Old Boy: Case Report and Review of Literature

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