Clinical outcomes of peroral endoscopic myotomy for achalasia in children: a systematic review and meta-analysis

Abstract

Peroral endoscopic myotomy (POEM) is a novel minimally invasive intervention, which has shown to be effective and safe for treating achalasia in adults. Presently, POEM was also reported to be effective for achalasia in children. So we conducted this study to explore the clinical outcomes of POEM for pediatric achalasia. A systematic literature search in PubMed, Embase, and Cochrane databases was performed, which covered the period from January 2009 to June 2020. Selecting studies and collecting data was independently by two reviewers according to predefined criteria. The statistical analysis was carried out using Comprehensive Meta-Analysis software version 2 and Review Manager 5.3. A total of 11 studies with 389 children were identified in the final analysis. Pooled technical success of POEM treatment achalasia was achieved in 385 children (97.4%; 95% confidence interval [CI], 94.7%–98.7%), and the pooled clinical success was achieved in 348 children (92.4%; 95% CI, 89.0%–94.8%). After POEM, the Eckardt score was significantly decreased by 6.76 points (95% CI, 6.18–7.34, P < 0.00001), and the lower esophageal sphincter pressure was significantly reduced by 19.38 mmHg (95% CI, 17.54–21.22, P < 0.00001). The pooled major adverse events rate related to POEM was 12.8% (95% CI, 4.5%–31.5%) and the gastroesophageal reflux rate was 17.8% (95% CI, 14.2%–22.0%). Our current study demonstrated that the POEM was an effective and safe technique for treating achalasia in children. Further randomized comparative studies of POEM and other therapeutic methods are warranted to determine the most effective treatment modality for achalasia in children.

Achalasia in Children and Adolescents

“…56 A 2021 systematic review and meta-analysis with a pooled sample of 389 patients reported technical success of 97.4% and clinical success of 93.9 (<1 year), 96.6% (1-3 years), and 95.5% (>3 years). 55 Long-term success of POEM was recently reported by Nabi et al where 94.7% of their patient cohort had clinical success at mean follow up of 68.5 months. 57 In 2019 retrospective study of 17 patients, Nabi et al reported similar clinical success between patients who were treatment naïve and those with history of previous treatments (Nabi2019) demonstrating the utility of POEM in children who have failed previous treatment modalities.…”

“…58 The abovementioned studies all reported success rates of >90% despite 21% to 29% of their cohorts having history of prior treatments. [54][55][56][57] Further studies are needed in pediatrics to determine if history of prior treatment(s) affects POEM outcomes.…”

“…A 2019 and 2021 systematic review and meta-analysis of pediatric studies both reported a significant decrease in Eckardt scores and LES pressures following POEM procedure. 54,55 Lee et al reported improvement or resolution of symptoms in 96% and 93% at short (<12 months) and long term (>12 months) follow up respectively. 54 An international multicenter retrospective study of 117 children reported clinical success in 90.6% who had mean follow up of 545 days.…”

“…60 In a recent systematic review and meta-analysis, Zhong et al reported 12.8% major adverse event rate including mucosal injury (4.6%), pneumothorax (3.0%), pneumonitis (4.4%), and pneumomediastinum (5.3%). 55 As POEM becomes more utilized in pediatrics it should be performed in centers that have proceduralist experience and patient volume.…”

Peroral Endoscopic Myotomy for Pediatric Achalasia: A Retrospective Analysis of 21 Cases With a Minimum Follow-Up of 5 Years

“…After Inoue et al described the first series of patients who received peroral endoscopic myotomy (POEM) in 2010 ( 11 ), POEM became a minimally invasive, rapid recovery, and preferred relatively novel procedure for achalasia in adults ( 12 , 13 ). Multiple studies have also confirmed its efficacy and safety in children and adolescent patients ( 14 – 21 ). However, the long-term follow-up study in children, notably more than 5 years, is unclear.…”