Introduction
Peroral endoscopic myotomy (POEM) is emerging as a minimally invasive therapeutic option for achalasia. Data are limited in pediatric population.
To compare the efficacy and safety of POEM in pediatric and adult patients with achalasia.
Aims & Methods
A prospective study was conducted, including all patients who underwent POEM, since August/2022, in a tertiary centre. Patients aged under 18yo were included in the pediatric group and above 18yo in adult group. Procedural-related parameters, adverse advents, pre- and post-intervention clinical, manometric and radiologic outcomes were evaluated.
Results
41 patients were included, including three children (mean age: 14.3±1.2vs.51.8±19.1yo; male gender: 100%(n=3)vs.39.5%(n=15)). According to the Chicago classification v4.0, all three children had type II achalasia (adults: type I-5.3%(n=2), type II-89.4%(n=34), type III-5.3%(n=2)). No significant differences were observed between groups in relation to clinical symptoms (Eckardt score (ES): 7.6vs.0.9;ρ=0.23; average duration of symptoms: 21vs.19months;ρ=0,36), pre-POEM integrated relaxation pressure (IRP) (36.7vs.19.0;ρ=0,11), esophagogastric junction contractile integral (EGJ-CI) (105,3vs.91,2;ρ=0.72) and barium swallow study at 1/5 minutes (4.5/5.1vs.12.6/10.0;ρ=0,17/0.29) and post-POEM IRP (9.75vs.6.19;ρ=0.32), EGJ-CI (7vs25.20;ρ=0.30) and barium swallow study (3.45/2.20vs.2.65/1.43;ρ=0.57/0.56), evaluated at 4.3±1.3 and 8.5±2.1months of follow-up. Technical success was 100% in all groups with mean procedure time of 91.7±12.6minutes for children (vs.86.1±21.6 for adults;ρ=0.35). Clinical success was similar in both groups (ES: children-0±0 vs. adults-0.31±0.63;ρ=0.69). There were no significant differences between groups regarding intraprocedural complications (67%vs.66%;ρ=0.98), post-procedural complications or major adverse events. No mortality or need for surgery. Symptomatic gastroesophageal reflux disease (GERD), successfully treated with daily PPI, was only observed in 5(13.2%) adults (vs. 0% of pediatric patients;ρ=0.021).
Conclusion
POEM proved to be effective and safe for achalasia both in adults and pediatric patients, with no statistically significant differences regarding technical, clinical, manometric and imaging success or complications. Achalasia should be treated as early as possible, with apparently lower incidence of post-POEM GERD in pediatric patients.
References
1. Rui Mendo, Pedro Barreiro, José Rodrigues, Catarina Félix, Catarina O'Neill, Iala Carina, Joyce Chivia, Cristina Chagas; Peroral Endoscopic Myotomy for
Esophageal Achalasia in Portugal: Outcomes of the First Prospective Series. GE Port J Gastroenterol 30 April 2021; 28 (3): 162–169.
