Background: Characterized by poor peristalsis of the esophagus in combination with increased
muscle tone and incomplete relaxation of the lower esophagus (LES). Achalasia is very
rare, occurring with an annual incidence of roughly one per 100,000 people. A recent
epidemiological analysis of the pediatric population showed an incidence of 0.18/100,000
per year. The occurrence of Esophageal Achalasia in very young children, especially<5
years of age, is extremely rare.
Case report: Female/12-month-26-day-old, coughing, and crying, vomiting after eating (since 5-month-old,
from June, vomiting count was risen). Her disease was diagnosed by X-Ray and endoscopy:
Stenosis located on the lower esophagus, stenosis length was 3.5cm and dilated esophageal
diameter was 3.3 cm. Her upper GI endoscopy shows the esophagus was filled with food
and liquid, dilated esophagus and stenosis. Performed POEM by using Fujinon EG 590ZW
(nasogastric scope-6mm). The endoscopic device and scope weren’t fit, so that we’d
made handmade additional channel for devices. After successful myotomy, the endoscope
was introduced into the stomach without difficulty. 2 months follow up, the patient
reported significant relief of dysphagia and her nutritional status was improved,
by endoscopy shows expanded cardiac sphincter and no another symptom [1]
[2]
[3]
[4]
[5].
Conclusion: Currently, effective endoscopic and surgical techniques are available, although there
is no defined therapeutic algorithm for the pediatric population, in international
practice. Therefore, in our case, POEM for the 1-year-old child was a technically
challenging procedure, which was the first time to perform POEM for this age of child.
