Per oral endoscopic myotomy (POEM) for pediatric achalasia cardia – technical considerations and outcomes analysis based on age defined subgroups

Aims Limited literature exists on per-oral endoscopic myotomy (POEM) for pediatric achalasia cardia (AC), with majority reporting generalized outcomes across a wide age group. Currently no studies discuss outcomes based on age defined subgroups. This study discusses technical modifications, clinical and technical outcomes based on an age defined subgroup analysis.

Methods Single center retrospective analysis of prospectively maintained database of pediatric patients undergoing POEM. Demographics, procedure details, technical outcomes, clinical outcomes, adverse events, follow up abstracted. Clinical success in age group>5y measured using Eckardt Score (ES), for those<5y – percentage weight gain at 1m follow up.

Results N=32, duration – 9y (2015-2024). Age (mean [SD])=10.52y (± 4.88), median (IQR)=11y (8). Achalasia subtype – I – 2, II – 29, III – 1. Age defined subgroups –<2y (3), 3-4y (2), 5-10y (10), 11-17y (17). Prior interventions – 6/32 (18.8%) (> 4y). Failure to thrive – 7/32 (21.8%), all<10y. Associated Triple A syndrome – 5/32 (15.6%). Pre-POEM optimization – 12/32 (37.5%) (nutritional – 6, infection control – 6). Technical modifications – modified POEM using ultra-slim gastroscope – 4 (12.5%) patients (< 2y – 3; 3-4y – 1). Myotomy length (cm, mean, SD)=7.48 (± 1.53) (< 2y=6±1.0, 3-4y=6±1.41, 5-10y=7.05±1.21, 11-17y=8.18±1.47). Peri-POEM antibiotics in all. Adverse events – 6/32 (18.8%) – fever – 5 – paracetamol, chest empyema – 1, required thoracoscopic decortication. ES (age>5y) improved significantly (pre-POEM 5.31±1.67 vs. post-POEM 0.27±0.53, p<0.01). In patients<5y age, mean percentage weight gain (1m)=11.7% (± 6.3). Median follow-up – 4.5y (IQR – 4.75, Range – 0.25-9) available for 29/32 (90.6%) patients. Recurrence – 1, treated by repeat POEM, clinical GER – 2 (EGD – grade A GER – 1, normal – 1).

Conclusions POEM is safe and effective in children. Technical modifications may be needed for smaller children – use of ultra-slim scope, shorter myotomy length. Pre-POEM optimization maybe required in one-third patients. Response is sustained at long-term follow up. Clinical outcomes are comparable to adult POEM patients.

 

MissingLinkText

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025