Treating children with achalasia using per-oral endoscopic myotomy (POEM): Twenty-one cases in review

Wood, L. D. H.; Chandler, Julia M.; Portelli, Katherine; Taylor, Jordan S.; Kethman, William; Wall, James

doi:10.1016/j.jpedsurg.2020.02.028

Cited by 22 publications

(22 citation statements)

References 14 publications

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“…Multiple studies have established the safety and efficacy of POEM in adults with achalasia. Emerging data suggest that POEM may be an effective treatment in children and adolescents as well (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). However, there are limited data on the long-term outcomes of POEM in the pediatric population.…”

Section: Introductionmentioning

confidence: 99%

POEM Is a Durable Treatment in Children and Adolescents With Achalasia Cardia

et al. 2022

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Background and AimPer-oral endoscopic myotomy (POEM) is emerging as an effective treatment for pediatric achalasia. There are limited data on the long-term efficacy of POEM in children and adolescents with achalasia. In this study, we aim to evaluate the outcomes of POEM at ≥4 years follow-up.MethodThe data of consecutive children who underwent POEM (September 2013–July 2021) and completed at least 4 years follow-up were analyzed retrospectively. The primary outcome was clinical success (Eckardt ≤ 3) at ≥4 years follow-up. The secondary outcomes included the prevalence of gastroesophageal reflux disease (GERD) and predictors of recurrent symptoms (Eckardt ≥2) after POEM.ResultsA total of 69 children underwent POEM for achalasia during the study period. Of these, 41 (59.4%) children completed ≥4 years [mean 68.5 months (range 48–94)] follow-up, and 38 were included in the final analysis. The subtypes of achalasia included type I (28.9%), type II (60.5%), and type III (2.6%). There was a history of prior treatment in 11 children (28.9%). Clinical success was recorded in 36 (94.7%) patients who successfully underwent POEM. Recurrent symptoms (Eckardt ≥ 2) were noticed in 12 (31.6%) children at ≥4 years. On multivariate analysis, there were no identifiable factors which predicted recurrent symptoms after POEM. Symptomatic GERD and erosive esophagitis were detected in 13.8% (4/29) and 57.1% (8/14) of the children, respectively.ConclusionPOEM is a durable treatment modality for achalasia in the pediatric population irrespective of the sub-type of achalasia and history of prior treatment.

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Section: Introductionmentioning

confidence: 99%

POEM Is a Durable Treatment in Children and Adolescents With Achalasia Cardia

et al. 2022

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“…Per-oral endoscopic myotomy (POEM), a modern treatment for achalasia, has only recently emerged as an option for pediatric patients. Wood reported in her study on 21 pediatric cases POEM to be a viable and safe treatment for pediatric patients with achalasia [54].…”

Section: Endoscopic Pediatric Surgerymentioning

confidence: 99%

Advances and Trends in Pediatric Minimally Invasive Surgery

Meinzer

Alkatout

Krebs

et al. 2020

JCM

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As many meta-analyses comparing pediatric minimally invasive to open surgery can be found in the literature, the aim of this review is to summarize the current state of minimally invasive pediatric surgery and specifically focus on the trends and developments which we expect in the upcoming years. Print and electronic databases were systematically searched for specific keywords, and cross-link searches with references found in the literature were added. Full-text articles were obtained, and eligibility criteria were applied independently. Pediatric minimally invasive surgery is a wide field, ranging from minimally invasive fetal surgery over microlaparoscopy in newborns to robotic surgery in adolescents. New techniques and devices, like natural orifice transluminal endoscopic surgery (NOTES), single-incision and endoscopic surgery, as well as the artificial uterus as a backup for surgery in preterm fetuses, all contribute to the development of less invasive procedures for children. In spite of all promising technical developments which will definitely change the way pediatric surgeons will perform minimally invasive procedures in the upcoming years, one must bear in mind that only hard data of prospective randomized controlled and double-blind trials can validate whether these techniques and devices really improve the surgical outcome of our patients.

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“…While the procedure is relatively new, the short-and long-term outcomes of the procedure appear to be comparable to LHM with the added benefit of having no incisions (30,31,33,(35)(36)(37). In a large single-center series, cases of recurrent symptoms requiring additional interventions were fairly high (16/21, 76%); wherein most required only pneumatic dilations (13/21); 2 patients required repeat POEM; and 1 required laparoscopic Heller myotomy to provide definitive symptom relief (37). In our own experience with POEM in children thus far (19 patients), 17 have sustained symptomatic relief (89.5%) and 2 have required reintervention.…”

Section: Peroral Endoscopic Myotomymentioning

confidence: 99%

“…In children, Choné et al found that the incidence of adverse events was relatively low (6%), with most of these cases classified as mild in severity (31). Other series, including a large, single-center analysis analyzing minimally invasive procedures for pediatric achalasia confirmed that POEM complications remained exceedingly low (30,35,37).…”

Section: Peroral Endoscopic Myotomymentioning

confidence: 99%

Current management of pediatric achalasia

Tashiro¹,

Petrosyan²,

Kane³

2021

Transl Gastroenterol Hepatol

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Achalasia is a rare condition affecting esophageal motility in children. In a manner similar to the disease found in the adult population, children experience symptoms of dysphagia, regurgitation, and chest pain due to a failure of relaxation of the lower esophageal sphincter. Standard diagnostic approaches include upper endoscopy and esophageal manometry. New developments in diagnosis include highresolution esophageal manometry and the endoscopic functional lumen imaging probe. Therapies available include endoscopic balloon dilations and botulinum toxin injections into the lower esophageal sphincter, as well as surgical interventions. The Heller myotomy was first described in 1913; since then, there have been many modifications to the procedure to improve outcomes and lower morbidity. Currently, the most commonly performed surgical procedure is the laparoscopic Heller myotomy, in which the sphincter muscle is divided using longitudinal incisions with or without a partial fundoplication procedure. In recent years, per oral endoscopic myotomy (POEM) is gaining support as a viable natural orifice therapy for achalasia.Complications of POEM occur at a relatively low rate, and outcomes following the procedure have been promising. The treatment of end-stage achalasia however, may include partial or total esophagectomy with reconstruction if possible. Future research is focused primarily on increasing the efficacy, and lowering complications, of existing therapeutic modalities.

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Treating children with achalasia using per-oral endoscopic myotomy (POEM): Twenty-one cases in review

Cited by 22 publications

References 14 publications

POEM Is a Durable Treatment in Children and Adolescents With Achalasia Cardia

POEM Is a Durable Treatment in Children and Adolescents With Achalasia Cardia

Advances and Trends in Pediatric Minimally Invasive Surgery

Current management of pediatric achalasia

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