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Eur J Pediatr Surg 2024; 34(01): 097-101
DOI: 10.1055/a-2156-5099
Original Article

Peroral Endoscopic Myotomy in Pediatric Patients with Achalasia up to 12 Years of Age: A Pilot Study in a Single-Center Experience in Japan

Yoshitomo Samejima 
1   Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
,
Shohei Yoshimura
1   Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
,
Yuichi Okata
1   Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
,
Hiroya Sakaguchi
2   Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
,
Hirofumi Abe
2   Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
,
Shinwa Tanaka
2   Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
3   Department of Internal Medicine, Tanaka Clinic, Kobe, Japan
,
Yuzo Kodama
2   Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
,
Yuko Bitoh
1   Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Abstract

Introduction Peroral endoscopic myotomy (POEM) is a minimally invasive endoscopic procedure for achalasia; its indication has expanded from adults to children. We aimed to evaluate the postoperative efficacy and antireflex status of POEM in young children with achalasia aged 12 years or younger.

Patients and Methods Pediatric patients with achalasia aged 18 years or younger who underwent POEM in our hospital between 2016 and 2021 were included and divided into two age groups: group A (≤ 12 years) and group B (13–18 years). The success rate (Eckardt score ≤ 3), endoscopic reflux findings, and antiacid use at 1 year postoperatively were compared between the groups.

Results Ten patients (four boys and six girls; Chicago classification type I: five, type II: four, and unclassified: one) were included. Mean age and preoperative Eckardt scores in groups A (n = 4) and B (n = 6) were 9.2 ± 3.0 versus 15.6 ± 0.6 years (p = 0.001) and 5.5 ± 3.9 versus 7.2 ± 3.7 (p = 0.509), respectively, and mean operative time and myotomy length were 51.3 ± 16.6 versus 52.5 ± 13.2 minutes (p = 0.898) and 10.8 ± 4.6 versus 9.8 ± 3.2 cm (p = 0.720), respectively. The 1-year success rate was 100% in both groups. Mild esophagitis (Los Angeles classification B) was endoscopically found in one patient in each group (16.7 vs. 25.0%, p = 0.714), and antiacid use was required in three patients (group A, two; group B, one; 50.0 vs. 16.7%, p = 0.500).

Conclusion The success rate of POEM within 1 year in young children with achalasia aged 12 years or younger was equal to that in adolescent patients. However, young children tended to require antiacids 1 year postoperatively; therefore, long-term follow-up is necessary.

Keywords

esophageal achalasia - gastroesophageal reflux disease - peroral endoscopic myotomy

Ethical Approval

This study was approved by the Institutional Review Board of the Kobe University Hospital, Kobe, Hyogo, Japan.




Publication History

Received: 14 May 2023

Accepted: 15 August 2023

Accepted Manuscript online:
18 August 2023

Article published online:
29 September 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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