Outcomes of treatment of childhood achalasia

Lee, Constance W.; Kays, David W.; Chen, Mike K.; Islam, Saleem

doi:10.1016/j.jpedsurg.2010.02.086

Cited by 84 publications

(94 citation statements)

References 19 publications

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“…[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. Inoue H. et al performed the first POEM in adults in 2008.…”

Section: Discussionmentioning

confidence: 99%

“…[23] Until now, laparoscopic Heller's myotomy has been considered the treatment of choice for achalasia in adults and children with excellent longterm results. [14][15][16][17] Conventional two-dimensional laparoscopic procedures lack the flexibility of instruments and the highquality three-dimensional imaging that are facilitated by the robot, especially in a narrow operation field with the need for advanced intracorporeal suturing. [2,5] In addition to these advantages, robotic surgery provides motion scaling with the elimination of hand tremors.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…Often, since there is a significant delay in diagnosis of achalasia in children, the esophagram study alone is diagnostic. Elevated resting LES pressure, absent or lowamplitude peristalsis, or non-relaxing LES upon swallowing are diagnostic findings on esophageal manometry in children with achalasia [1,2] . However, absence of these findings does not rule out the diagnosis of achalasia since LES function in children is heterogeneous.…”

Section: Diagnosismentioning

confidence: 99%

“…The disease is even more infrequent in children less than 5 years of age. The incidence of achalasia in childhood is 0.11/100000 children annually [1,2] . Overall, less than 5% of patients with symptoms present under the age of 15 [3] .…”

Section: Introductionmentioning

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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An updated incidence of paediatric achalasia and number of myotomies performed in the United Kingdom

Dokal

Mutalib

2021

GastroHep

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Background: Achalasia is a rare condition characterised by an absent oesophageal peristalsis and a non-relaxing lower oesophageal sphincter. The incidence of paediatric achalasia is poorly studied and inconsistently reported. We aimed to provide an up to date incidence of paediatric achalasia in the UK.Methods: All United Kingdom hospitals with paediatric gastroenterology and/or paediatric surgery were contacted to provide data on achalasia diagnosis and myotomies performed (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019)(2020). Hospital Episode Statistics includes diagnostic and procedural data for all hospitals in England that were searched for achalasia and myotomy in children . Proxy data (epilepsy diagnosis) were used to compare diagnosis. Results:The incidence of paediatric achalasia in the UK was 0.38 (England 0.43, Wales 0.09, Scotland 0.15 and Northern Ireland 0.17) per 100 000 population per year. The number of myotomies performed remained stable with an average of (±SD) 11.6 (±5) from 2000 to 2020, however, there was a gradual increase in achalasia admissions 58.4 (±19) in the same time period. Using epilepsy as proxy condition, hospitals appear to diagnose achalasia predominantly from their geographic catchment population raising concerns about underdiagnosing achalasia in children. Conclusion:The incidence of paediatric achalasia in the UK is significantly higher than previously reported. Although this is still lower than the incidence in adults, the gap is narrowing. There is evidence to suggest an ongoing underdiagnosis of achalasia in childhood contributing to the wide variation in care across the UK.

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Outcomes of treatment of childhood achalasia

Cited by 84 publications

References 19 publications

Robot-assisted Heller’s myotomy for achalasia in children

Robot-assisted Heller’s myotomy for achalasia in children

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

An updated incidence of paediatric achalasia and number of myotomies performed in the United Kingdom

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