Although per-oral endoscopic myotomy (POEM) was a suggested therapy for achalasia, there is little published data on its usage in children. The researchers from the study sought to determine if POEM is clinically effective and safe for children. An international multicenter retrospective analysis was undertaken in 14 tertiary facilities involving consecutive children who received POEM between January 2012 and August 2018. When available, outcomes such as clinical response were evaluated. Adverse events and risk factors for clinical failure were also explored.
POEM was performed on 117 patients (mean ± SD age: 14.2 ± 3.7 years) with achalasia (type I, n = 36; type II n=66; type III, n=8). Thirty of these (26%) were pretreated (botulinum injection and/or pneumatic dilatation). Mean ± SD baseline Eckardt score was 7.5 ± 2.0 post POEM. In the intention-to-treat analysis, clinical success was obtained in 90.6% (95%CI [83.8%;95.2%]) of patients. After POEM, the mean ± SD Eckardt score was 0.9 ± 1.2 (P < 0.001). The average length of follow-up was 545 days (range: 100–1612). There was a total of seven adverse occurrences (4 microtomies, 2 subcutaneous emphysema, 1 esopleural fistula). Gastroesophageal reflux symptoms were observed in 17 patients (15%), with 10 patients having missing data (9%). In achalasia linked with genetic diseases, there was a tendency toward more frequent clinical failure (40% vs 8%, P = 0.069).
POEM seemed to be efficacious and safe in young patients, while there was a tendency toward more frequent clinical failure achalasia linked with hereditary diseases. More research is needed to examine long-term effects, particularly the repercussions of GERD.
Reference:journals.lww.com/jpgn/Fulltext/2019/11000/Multicenter_Evaluation_of_Clinical_Efficacy_and.3.aspx
