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Gastrointest Endosc. 2015 Jan;81(1):91-100. doi: 10.1016/j.gie.2014.06.035. Epub 2014 Aug 1.

Long-term outcomes of peroral endoscopic myotomy for achalasia in pediatric patients: a prospective, single-center study.

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  • 1Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.

Abstract

BACKGROUND:

Peroral endoscopic myotomy (POEM) has been developed to provide a less-invasive myotomy for achalasia in adults but seldom has been used in pediatric patients.

OBJECTIVE:

To evaluate the feasibility, safety, and efficacy of POEM for pediatric patients with achalasia.

DESIGN:

Single-center, prospective study.

SETTING:

Academic medical center.

PATIENTS:

A total of 27 pediatric patients (mean age 13.8 years, range 6-17 years) with achalasia.

INTERVENTIONS POEM MAIN OUTCOME MEASUREMENTS:

The primary outcome was symptom relief during follow-up, defined as an Eckardt score of ≤3. Secondary outcomes were procedure-related adverse events, clinical reflux adverse events, and lower esophageal sphincter (LES) pressure on manometry before and after POEM.

RESULTS:

A total of 26 cases (96.3%) underwent successful POEM. A submucosal tunnelling attempt failed in 1 case because of serious inflammation and adhesion. No serious adverse events related to POEM were encountered. During a mean follow-up period of 24.6 months (range 15-38 months), treatment success was achieved in all patients (mean score before vs after treatment 8.3 vs 0.7; P < .001). Mean LES pressure also decreased from a mean of 31.6 mm Hg to 12.9 mm Hg after POEM (P < .001). Five patients developed clinical reflux adverse events (19.2%).

LIMITATIONS:

Single center and lack of some objective evaluations.

CONCLUSION:

This relatively long-term follow-up study adds to the evidence that POEM seems to be a promising new treatment for pediatric patients with achalasia, resulting in long-term symptom relief in all cases and without serious adverse events.

Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

[PubMed - indexed for MEDLINE]
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