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Short-term safety and efficacy of peroral endoscopic myotomy for the treatment of achalasia in children

  • 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
  • Quanlin LiEmail author
  • Pinghong ZhouEmail author
Original Article—Alimentary Tract
  • 49 Downloads

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

POEM Achalasia Children Outcome 

Abbreviations

POEM

Peroral endoscopic myotomy

LES

Lower esophageal sphincter

mAEs

Major adverse events

EGD

Esophagogastroduodenoscopy

CO2

Carbon dioxide

ICU

Intensive care unit

rePOEM

Repeat POEM

Notes

Acknowledgements

All authors have none to declare.

Author contributions

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.

Funding

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

None disclosed.

Supplementary material

535_2019_1607_MOESM1_ESM.docx (42 kb)
Supplementary file1 (DOCX 42 kb)
535_2019_1607_MOESM2_ESM.tif (3.1 mb)
Supplementary file2 (TIFF 3194 kb)
535_2019_1607_MOESM3_ESM.tif (856 kb)
Supplementary file3 (TIFF 856 kb)
535_2019_1607_MOESM4_ESM.tif (9.1 mb)
Supplementary file4 (TIFF 9270 kb)

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Copyright information

© Japanese Society of Gastroenterology 2019

Authors and Affiliations

  • Zuqiang Liu
    • 1
  • Yun Wang
    • 1
  • Ying Fang
    • 2
  • Ying Huang
    • 3
  • Hongbin Yang
    • 2
  • Xiaoxia Ren
    • 2
  • Meidong Xu
    • 1
  • Shiyao Chen
    • 1
  • Weifeng Chen
    • 1
  • Yunshi Zhong
    • 1
  • Yiqun Zhang
    • 1
  • Wenzheng Qin
    • 1
  • Jianwei Hu
    • 1
  • Mingyan Cai
    • 1
  • Liqing Yao
    • 1
  • Quanlin Li
    • 1
    Email author
  • Pinghong Zhou
    • 1
    Email author
  1. 1.Endoscopy Center and Endoscopy Research Institute, Zhongshan HospitalFudan UniversityShanghaiPeople’s Republic of China
  2. 2.Department of GastroenterologyThe Children’s Hospital of Xi’an CityXi’anChina
  3. 3.Department of Gastroenterology, Children’s HospitalFudan UniversityShanghaiChina

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