Endoscopy 2018; 50(04): S46
DOI: 10.1055/s-0038-1637165
ESGE Days 2018 oral presentations
20.04.2018 – Motility disorders
Georg Thieme Verlag KG Stuttgart · New York

PERORAL ENDOSCOPIC MYOTOMY FOR THE TREATMENT OF ACHALASIA IN CHILDREN: EXPERIENCE OF A SINGLE CENTER WITH LONG TERM FOLLOW-UP

F Mangiola
1   Fondazione Policlinico Agostino Gemelli, Rome, Italy
,
P Familiari
1   Fondazione Policlinico Agostino Gemelli, Rome, Italy
,
R Landi
1   Fondazione Policlinico Agostino Gemelli, Rome, Italy
,
A Cali'
1   Fondazione Policlinico Agostino Gemelli, Rome, Italy
,
F Borrelli De Andreis
1   Fondazione Policlinico Agostino Gemelli, Rome, Italy
,
V Bove
1   Fondazione Policlinico Agostino Gemelli, Rome, Italy
,
F D'Aversa
1   Fondazione Policlinico Agostino Gemelli, Rome, Italy
,
A Costantini
1   Fondazione Policlinico Agostino Gemelli, Rome, Italy
,
I Boskoski
1   Fondazione Policlinico Agostino Gemelli, Rome, Italy
,
A Tringali
1   Fondazione Policlinico Agostino Gemelli, Rome, Italy
,
V Perri
1   Fondazione Policlinico Agostino Gemelli, Rome, Italy
,
G Costamagna
1   Fondazione Policlinico Agostino Gemelli, Rome, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

 

Aims:

Peroral Endoscopic Myotomy (POEM) is widely used for treatment of achalasia. POEM has been also occasionally performed for the management of paediatric achalasia. We report on a large series of children with achalasia, treated with POEM in a single center with long-term follow-up.

Methods:

From January 2012 to June 2017, 26 children (46.2% male, mean age 10.9 ± 4.5, range 2 – 17 years) with achalasia underwent POEM. Eckardt score (ECKs) was used for symptoms evaluation. Two children had already undergone pneumatic dilation. Two children were affected from Down syndrome and two children were affected from Allgrove syndrome. Twenty children underwent high resolution manometry [HRM] (25% type I, 70% type II, 5% type III of achalasia).

Results:

POEM was successfully completed in 25 cases; one procedure was interrupted because of massive submucosal fibrosis, probably caused by the previous 4 pneumatic dilations. Mean symptoms duration before POEM was 18.2 ± 14.9 months. Mean preoperative 4sIRP was 33.2 ± 12.2 mmHg. Mean preoperative ECKs was 7.2 ± 2.2. All patient underwent an EGD before starting oral feeding. Small ulcerations of the EGJ were seen in 16%, but patients were regularly fed. One patient experienced an oesophageal leak, managed conservatively. One patient had ab-ingestis pneumonia after POEM. No other complications occurred. After a mean follow-up of 30.6 ± 15.0 months, all the treated patients had an ECKs< 3 and normal growth curve by age. At 6 or 12 month after POEM, 17 patients underwent HRM and 24-hours pH-monitoring. Mean 4IRP was 8.5 ± 4.7 mmHg. Pathologic oesophageal acid exposure has been detected in four children; two of them had a grade-A esophagitis.

Conclusions:

POEM is a minimally-invasive procedure for treatment of achalasia in paediatric patients. Our results confirm the long term efficacy of POEM in children, in absence of severe complications. Gastroesophageal reflux has been detected in a small percentage of treated patients.