Short-term safety and efficacy of peroral endoscopic myotomy for the treatment of achalasia in children
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Peroral endoscopic myotomy (POEM) has shown excellent results for the treatment of achalasia in adults, but studies for children are limited. The study was aimed to analyze outcomes of peroral endoscopic myotomy (POEM) in children and compared with those in adults in a large multi-center study.
Records of consecutive patients with achalasia who underwent POEM at three tertiary centers were reviewed. A total of 130 children were included in this study. The primary outcomes of perioperative outcomes and clinical follow-up data were analyzed.
One child (0.8%) experienced technical failure. Five children (3.8%) had major adverse events, including one with pneumothorax requiring drainage, two with delayed mucosa barrier failure, one with readmission, and one with vital-sign instability. Both post-POEM Eckardt score and median LES pressure were significantly lower than their pre-POEM reference values in children (0.7 vs 7.4; 7.0 vs 27.1 mmHg; both P < 0.001). During a median follow-up time of 40 months, clinical reflux rate was 27.0% and clinical failure rates at 1, 3, and 5 years were 1.8%, 3.5%, and 4.4% for children. The technical failure, major adverse events, and postoperative clinical reflux were comparable between children and adults (all P > 0.05). Kaplan–Meier analysis showed that the risk of clinical failure was lower in children than adults (log-rank test, hazard ratio = 0.37, 95% confidence interval 0.15–0.91, P = 0.023).
POEM can be safely performed in children with achalasia, and produce a better clinical response during long-term follow-up compared with that in adults.
KeywordsPOEM Achalasia Children Outcome
Peroral endoscopic myotomy
Lower esophageal sphincter
Major adverse events
Intensive care unit
All authors have none to declare.
Planning and conducting the study: Quanlin Li and Pinghong Zhou; Collecting data: Zuqiang Liu, Yun Wang, Ying Fang, Ying Huang, Hongbin Yang, Xiaoxia Ren, Meidong Xu, Shiyao Chen, Weifeng Chen, Yunshi Zhong, Yiqun Zhang, Wenzheng Qin, Jianwei Hu, Mingyan Cai, Liqing Yao; Analyzing and interpreting data: Zuqiang Liu, Yun Wang; Drafting manuscript: Zuqiang Liu, Quanlin Li; Final approval of manuscript: All authors.
This study was supported by grants from the National Natural Science Foundation of China (81873552, 81470811, 81570595, and 81670483), Shanghai Rising Star Program (19QA1401190), Major Project of Shanghai Municipal Science and Technology Committee (18ZR1406700, 16411950400, 16DZ2280900), Chen Guang Program of Shanghai Municipal Education Commission (15CG04), and Outstanding Young Doctor Training Project of Shanghai Municipal Commission of Health and Family Planning (2017YQ026), Xi'an hygiene and health commission, Key disciplines and dominant specialties program (2015038), and the Project of Shanghai Municipal Commission of Health and Family Planning (SHDC12016203).
Compliance with ethical standards
Conflict of interest
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