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Mussies C, van Lennep M, van der Lee JH, Singendonk MJ, Benninga MA, Bastiaansen BA, Fockens P, Bredenoord AJ, van Wijk MP. Protocol for an international multicenter randomized controlled trial assessing treatment success and safety of peroral endoscopic myotomy vs endoscopic balloon dilation for the treatment of achalasia in children. PLoS One 2023; 18:e0286880. [PMID: 37796851 PMCID: PMC10553306 DOI: 10.1371/journal.pone.0286880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/13/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Achalasia is a rare neurodegenerative esophageal motility disorder characterized by incomplete lower esophageal sphincter (LES) relaxation, increased LES tone and absence of esophageal peristalsis. Achalasia requires invasive treatment in all patients. Conventional treatment options include endoscopic balloon dilation (EBD) and laparoscopic Heller's myotomy (LHM). Recently, a less invasive endoscopic therapy has been developed; Peroral Endoscopic Myotomy (POEM). POEM integrates the theoretical advantages of both EBD and LHM (no skin incisions, less pain, short hospital stay, less blood loss and a durable myotomy). Our aim is to compare efficacy and safety of POEM vs. EBD as primary treatment for achalasia in children. METHODS AND ANALYSIS This multi-center, and center-stratified block-randomized controlled trial will assess safety and efficacy of POEM vs EBD. Primary outcome measure is the need for retreatment due to treatment failure (i.e. persisting symptoms (Eckardt score > 3) with evidence of recurrence on barium swallow and/or HRM within 12 months follow-up) as assed by a blinded end-point committee (PROBE design). DISCUSSION This RCT will be the first one to evaluate which endoscopic therapy is most effective and safe for treatment of naïve pediatric patients with achalasia.
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Affiliation(s)
- Carlijn Mussies
- Emma Children’s Hospital—Amsterdam UMC, Location University of Amsterdam, Pediatric Gastroenterology, Amsterdam, The Netherlands
| | - Marinde van Lennep
- Emma Children’s Hospital—Amsterdam UMC, Location University of Amsterdam, Pediatric Gastroenterology, Amsterdam, The Netherlands
| | - Johanna H. van der Lee
- Emma Children’s Hospital—Amsterdam UMC, Location University of Amsterdam, Pediatric Clinical Research Office, Amsterdam, The Netherlands
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Maartje J. Singendonk
- Emma Children’s Hospital—Amsterdam UMC, Location University of Amsterdam, Pediatric Gastroenterology, Amsterdam, The Netherlands
| | - Marc. A. Benninga
- Emma Children’s Hospital—Amsterdam UMC, Location University of Amsterdam, Pediatric Gastroenterology, Amsterdam, The Netherlands
| | - Barbara A. Bastiaansen
- Gastroenterology & Hepatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Paul Fockens
- Gastroenterology & Hepatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Gastroenterology & Hepatology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Albert J. Bredenoord
- Gastroenterology & Hepatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel P. van Wijk
- Emma Children’s Hospital—Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Abstract
OBJECTIVES Pediatric achalasia is a rare neurodegenerative disorder of the esophagus that requires treatment. Different diagnostic and treatment modalities are available, but there are no data that show how children can best be diagnosed and treated. We aimed to identify current practices regarding the diagnostic and therapeutic approach toward children with achalasia. METHODS Information on the current practice regarding the management of pediatric achalasia was collected by an online-based survey sent to members of the European and North American Societies for Pediatric Gastroenterology Hepatology and Nutrition involved in pediatric achalasia care. RESULTS The survey was completed by 38 centers from 24 countries. Within these centers, 108 children were diagnosed with achalasia in the last year (median 2, range 0-15). Achalasia was primarily managed by a pediatric gastroenterologist (76%) and involved a multidisciplinary team in 84% of centers, also including a surgeon (87%), radiologist (61%), dietician (37%), speech pathologist (8%), and psychologist (5%). Medical history taking and physical examination were considered most important to establish the diagnosis (50%), followed by (a combination of) manometry (45%) or contrast swallow (21%). Treatment of first choice was Heller myotomy (58%), followed by pneumatic dilation (46%) and peroral endoscopic myotomy (29%). CONCLUSION This study shows a great heterogeneity in the management of pediatric achalasia amongst different centers worldwide. These findings stress the need for well-designed intervention trials in children with achalasia. Given the rarity of this disease, we recommend that achalasia care should be managed in centers with access to appropriate diagnostic and treatment modalities.
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Knowles SR, Graff LA, Wilding H, Hewitt C, Keefer L, Mikocka-Walus A. Quality of Life in Inflammatory Bowel Disease: A Systematic Review and Meta-analyses-Part I. Inflamm Bowel Dis 2018; 24:742-751. [PMID: 29562277 DOI: 10.1093/ibd/izx100] [Citation(s) in RCA: 248] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Quality of life (QoL) is commonly assessed in inflammatory bowel disease (IBD); the relationship of QoL within IBD states and relative to others has not been comprehensively evaluated. This systematic review, published across 2 papers, evaluates 5 key QoL comparisons. Part I, presented here, examines between-disease comparisons: (1) IBD/healthy(general) population and (2) IBD/other medically ill groups. Part II examines within-disease comparisons: (3) active/inactive disease, (4) ulcerative colitis/Crohn's disease, and (5) change over time. Outcomes using generic vs IBD-specific QoL measures were also examined. METHODS Adult and pediatric studies were identified through systematic searches of 7 databases from the 1940s (where available) to October 2015. RESULTS Of 6173 abstracts identified, 466 were selected for final review based on controlled design and validated measurement; 30 unique studies (23 adult, 7 pediatric) addressed the between-disease comparisons. The pooled mean QoL scores were (1) lower in adult and pediatric IBD samples compared with healthy controls (n = 19), and for both mental and physical QoL, where measured; and (2) higher but not significant for those with IBD compared with various medically ill controls (n = 15). Findings were consistent across IBD-specific and generic QoL measures. Study quality was generally low to moderate. The most common measures of QoL were the disease-specific Inflammatory Bowel Disease Questionnaire and generic SF-36 (adults), and the generic PedsQL (children). CONCLUSIONS There was robust confirmation that QoL for individuals with IBD was poorer than for healthy individuals, for both adults and children. QoL in IBD may be better relative to some other gastrointestinal (GI) and non-GI medical conditions for children.
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Affiliation(s)
- Simon R Knowles
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia.,Department of Mental Health, St Vincent's Hospital, Melbourne, Australia.,Department of Library Service, St Vincent's Hospital, Melbourne, Australia.,Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia
| | - Lesley A Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Helen Wilding
- Department of Mental Health, St Vincent's Hospital, Melbourne, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, United Kingdom
| | - Laurie Keefer
- Division of Gastroenterology, Ichan School of Medicine at Mount Sinai, New York, New York
| | - Antonina Mikocka-Walus
- Department of Health Sciences, University of York, York, United Kingdom.,School of Psychology, University of Adelaide, Adelaide, Australia.,School of Psychology, Deakin University, Burwood, Australia
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Peroral Endoscopic Myotomy in Children With Achalasia: A Relatively Long-term Single-center Study. J Pediatr Gastroenterol Nutr 2018; 66:257-262. [PMID: 28691974 DOI: 10.1097/mpg.0000000000001675] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Achalasia is a disease caused by neuromuscular dysfunction in the esophagogastric junction, with a relatively low incidence among children. Peroral endoscopic myotomy (POEM) is a new endoscopic procedure for the treatment of achalasia; however, it is rarely applied in children. OBJECTIVES We aim to study the feasibility, safety, and effectiveness of POEM as a treatment for pediatric achalasia. METHODS A total of 21 pediatric patients (ages from 11 months to 18 years) diagnosed as having achalasia and treated with POEM from October of 2014 to October of 2016 in our hospital were included in our study. Indices such as clinical manifestations, nutritional status, Eckardt scores, high-resolution esophageal manometric measurements, gastroduodenoscopic findings, and upper gastroenterographic findings after treatment were respectively compared with those before treatment to analyze the effectiveness and safety of POEM. RESULTS All of the 21 children successfully received POEM. The patients were followed up for duration ranged from 3 to 24 months. Among these children, symptoms such as vomiting and dysphagia were significantly alleviated or resolved. The Eckardt scores had an average drop of 7 points after treatment compared with those before treatment. Postoperative gastroduodenoscopy and upper gastroenterography showed that the opening of the cardiac orifice was significantly enlarged and obstruction at the lower esophagus was significantly relieved. CONCLUSIONS POEM is a mini-invasive technique and a promising new treatment for pediatric patients, making it worthy of further clinical research and application.
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Meyer A, Catto-Smith A, Crameri J, Simpson D, Alex G, Hardikar W, Cameron D, Oliver M. Achalasia: Outcome in children. J Gastroenterol Hepatol 2017; 32:395-400. [PMID: 27411173 DOI: 10.1111/jgh.13484] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Oesophageal achalasia is well-recognized but relatively rare in children, occasionally appearing as the "triple A" syndrome (with adrenal insufficiency and alacrima). Treatment modalities, as in adult practice, are not curative, often needing further interventions and spurring the search for better management. The outcome for syndromic variants is unknown. We sought to define the efficacy of treatments for children with achalasia with and without triple A syndrome. METHODS We conducted a retrospective analysis of presentation and outcomes for 42 children with achalasia presenting over three decades to a major pediatric referral center. Long term impact of the diagnosis was assessed by questionnaire. RESULTS We identified 42 children including six with triple A syndrome. The median overall age at diagnosis was 10.8 years and median follow-up 1593 days. Initial Heller myotomy in 17 required further interventions in 11 (65%), while initial treatment with botulinum toxin (n = 20) was ultimately followed by myotomy in 17 (85%). Ten out of 35 patients who underwent myotomy required a repeat myotomy (29%). Patients with triple A syndrome developed symptoms earlier, but had delayed diagnosis, were more underweight at diagnosis and at last follow up. Questionnaire results suggested a significant long term deleterious impact on the quality of life of children and their families. CONCLUSION Many children with achalasia relapse after initial treatment, undergoing multiple, different procedures, despite which symptoms persist and impact on quality of life. Symptoms develop earlier in patients with triple A syndrome, but the diagnosis is delayed and this has substantial nutritional impact.
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Affiliation(s)
- Anell Meyer
- Department of Gastroenterology and Clinical Nutrition, Australia.,Department of Pediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - Anthony Catto-Smith
- Department of Gastroenterology and Clinical Nutrition, Australia.,Department of Pediatrics, University of Melbourne, Australia.,Murdoch Children's Research Institute, Australia.,Queensland University of Technology and Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Joe Crameri
- Department of Surgery, The Royal Children's Hospital Melbourne, Victoria, Australia
| | - Di Simpson
- Department of Gastroenterology and Clinical Nutrition, Australia
| | - George Alex
- Department of Gastroenterology and Clinical Nutrition, Australia
| | - Winita Hardikar
- Department of Gastroenterology and Clinical Nutrition, Australia.,Department of Pediatrics, University of Melbourne, Australia.,Murdoch Children's Research Institute, Australia
| | - Donald Cameron
- Department of Gastroenterology and Clinical Nutrition, Australia.,Department of Pediatrics, University of Melbourne, Australia.,Murdoch Children's Research Institute, Australia
| | - Mark Oliver
- Department of Gastroenterology and Clinical Nutrition, Australia.,Department of Pediatrics, University of Melbourne, Australia.,Murdoch Children's Research Institute, Australia
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Smits M, van Lennep M, Vrijlandt R, Benninga M, Oors J, Houwen R, Kokke F, van der Zee D, Escher J, van den Neucker A, de Meij T, Bodewes F, Schweizer J, Damen G, Busch O, van Wijk M. Pediatric Achalasia in the Netherlands: Incidence, Clinical Course, and Quality of Life. J Pediatr 2016; 169:110-5.e3. [PMID: 26616251 DOI: 10.1016/j.jpeds.2015.10.057] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 09/08/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess incidence and clinical course of Dutch patients with achalasia diagnosed before 18 years of age as well as their current symptoms and quality of life (QoL). STUDY DESIGN Retrospective medical chart review and a cross-sectional study assessing current clinical status using the Eckardt score and reflux disease questionnaire. General QoL was measured using Kidscreen-52 for patients <18 years of age or to 36-Item Short Form Health Survey for patients ≥18 years of age. RESULTS Between 1990 and 2013, 87 children (mean age 11.4 ± 3.4 years, 60% male) diagnosed with achalasia in the Netherlands were included. Mean incidence was 0.1/100,000/y (range 0.03-0.21). Initial treatment was pneumodilation (PD) in 68 (79%) patients and Heller myotomy (HM) in 18 (21%) patients. Retreatment was required more often after initial PD compared with initial HM (88% vs 22%; P < .0001). More complications of initial treatment occurred after HM compared with PD (55.6% vs 1.5%; P < .0001). Three esophageal perforations were seen after HM (16.7%), 1 after PD (1.5%). Sixty-three of 87 (72%) patients were prospectively contacted. Median Eckardt score was 3 (IQR 2-5), with 32 patients (44.5%) having positive scores suggesting active disease. Reflux disease questionnaire scores were higher after initial HM vs PD (1.71 [0.96-2.90] vs 0.58 [0-1.56]; P = .005). The 36-Item Short Form Health Survey (n = 52) was lower compared with healthy population norms for 7/8 domains. Kidscreen-52 (n = 20) was similar to population norms. CONCLUSIONS Pediatric achalasia is rare and relapse rates are high after initial treatment, especially after pneumodilation, but with more complications after HM. Symptoms often persist into adulthood, without any clinical follow-up. QoL in adulthood was decreased.
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Affiliation(s)
- Marije Smits
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | - Marinde van Lennep
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | - Remy Vrijlandt
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | - Marc Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | - Jac Oors
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | - Roderick Houwen
- Department of Pediatric Gastroenterology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands
| | - Freddy Kokke
- Department of Pediatric Gastroenterology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, the Netherlands
| | - David van der Zee
- Department of Pediatric Surgery, University Medical Center, Utrecht, the Netherlands
| | - Johanne Escher
- Department of Pediatric Gastroenterology, Sophia Children's Hospital, Erasmus MC, Rotterdam, the Netherlands
| | - Anita van den Neucker
- Department of Pediatric Gastroenterology, University Medical Center, Maastricht, the Netherlands
| | - Tim de Meij
- Department of Pediatric Gastroenterology, Vrije Universiteit MC, Amsterdam, the Netherlands
| | - Frank Bodewes
- Department of Pediatric Gastroenterology, Beatrix Children's Hospital, University Medical Center-Groningen, Groningen, the Netherlands
| | - Joachim Schweizer
- Department of Pediatric Gastroenterology, Willem-Alexander Children's Hospital, University Medical Center, Leiden, the Netherlands
| | - Gerard Damen
- Department of Pediatric Gastroenterology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Olivier Busch
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Michiel van Wijk
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
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Persson J, Johnsson E, Kostic S, Lundell L, Smedh U. Treatment of achalasia with laparoscopic myotomy or pneumatic dilatation: long-term results of a prospective, randomized study. World J Surg 2015; 39:713-20. [PMID: 25409838 DOI: 10.1007/s00268-014-2869-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND This study compares the long-term results of pneumatic dilatations versus laparoscopic myotomy using treatment failure as the primary outcome. The frequency and degree of dysphagia, the effects on quality of life (QoL), and health economy were also examined. METHODS Fifty-three patients with achalasia were randomized to laparoscopic myotomy with a posterior partial fundoplication [laparoscopic myotomy (LM) n = 25] or repetitive pneumatic dilatation [pneumatic dilatation (PD) n = 28]. The median observation period was 81.5 months (range 12-131). RESULTS At the minimal follow-up of 5 years, ten patients (36%) in the dilatation group and two patients (8%) in the myotomy group, including two patients lost to follow-up (one in each arm), were classified as failures (p = 0.016). The cumulative incidence of treatment failures was analyzed by survival statistics. Taking the entire follow-up period into account, a significant difference was observed in favor of the LM strategy (p = 0.02). Although both treatments resulted in significant improvements in dysphagia scores, LM was significantly favored over PD after 1 and 3 years, but not after 5 years. Health-related QoL assessed by the personal general well being score was higher in the LM group after 3 years, but the difference was not fully statistically significant at 5 years. Direct medical costs during the entire follow-up period were in median $13,421 for LM as compared to $5,558 for PD (p = 0.001). CONCLUSIONS This long-term follow-up of a randomized clinical study shows that LM is superior to repetitive PD treatment of newly diagnosed achalasia, albeit that this surgical strategy is burdened by high initial direct medical costs. www.ClinicalTrials.gov NCT 02086669.
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Affiliation(s)
- Jan Persson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, 41345, Gothenburg, Sweden,
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Kovacic K, Sood MR, Mugie S, Di Lorenzo C, Nurko S, Heinz N, Ponnambalam A, Beesley C, Sanghavi R, Silverman AH. A multicenter study on childhood constipation and fecal incontinence: effects on quality of life. J Pediatr 2015; 166:1482-7.e1. [PMID: 26008173 DOI: 10.1016/j.jpeds.2015.03.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/16/2015] [Accepted: 03/09/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe the effects of childhood functional constipation compared with functional constipation plus fecal incontinence on quality of life, evaluating effects on physical, psychosocial, and family functioning. STUDY DESIGN This prospective, multicenter study collected data from 5 regional children's hospitals. Children meeting Rome III criteria for functional constipation were included. Parents completed the following 5 instruments: Pediatric Quality of Life Inventory (PedsQL), PedsQL-Family Impact Module, Functional Disability Inventory-Parent Version, Pediatric Inventory for Parents (PIP), and Pediatric Symptom Checklist-Parent Report. RESULTS Families of 410 children aged 2-18 years (mean [SD], 7.8 [3.5] years; 52% male) were included. Children with functional constipation+fecal incontinence had worse quality of life than children with functional constipation alone (PedsQL Total Score, P ≤ .03). Older children with functional constipation + fecal incontinence had lower quality of life than their younger counterparts (PedsQL Total Score, P ≤ .047). Children with functional constipation+fecal incontinence had worse family functioning (PedsQL-Family Impact Module Total Score, P ≤ .012), greater parental stress (PIP-F Total Score, P ≤ .016; PIP-D Total Score, P ≤ .013), and poorer psychosocial functioning (Pediatric Symptom Checklist Total Score, P ≤ .003). There were no statistically significant between-group differences in physical functioning based on the functional Disability Inventory. CONCLUSION Fecal incontinence significantly decreases quality of life compared with functional constipation alone in children. Older children with functional constipation+fecal incontinence may be at particular risk. Strategies for early identification and treatment of constipation along with diagnosis and treatment of related adjustment difficulties may mitigate the negative impact of this highly prevalent condition.
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Affiliation(s)
- Katja Kovacic
- Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI
| | - Manu R Sood
- Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI
| | - Suzanne Mugie
- Division of Pediatric Gastroenterology, Nationwide Children's Hospital, Columbus, OH
| | - Carlo Di Lorenzo
- Division of Pediatric Gastroenterology, Nationwide Children's Hospital, Columbus, OH
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA
| | - Nicole Heinz
- Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA
| | - Ananthasekar Ponnambalam
- Division of Pediatric Gastroenterology, University of South Alabama Children's and Women's Hospital, Mobile, AL
| | - Christina Beesley
- Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI
| | - Rina Sanghavi
- Division of Pediatric Gastroenterology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Alan H Silverman
- Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI
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Peroral endoscopic myotomy for treatment of achalasia in children and adolescents. J Pediatr Surg 2015; 50:201-5. [PMID: 25598123 DOI: 10.1016/j.jpedsurg.2014.10.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 09/08/2014] [Accepted: 10/01/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Peroral endoscopic myotomy (POEM) is a novel endoscopic technique for treatment of achalasia (AC) and has shown exciting results in adults. However, little is known about the safety and efficacy of POEM in children and adolescents. Herein we report our preliminary results of POEM for children and adolescents with AC. METHODS POEM was performed in 9 consecutive patients with AC, whose age ranged from 10 to 17years. After submucosal injection, a submucosal tunnel was created. Endoscopic myotomy of muscle bundles was then achieved under direct vision. The mucosal entry was closed by several clips. A validated clinical symptom score (Eckardt score), LES pressure, esophageal diameters and procedure-related complications were used to evaluate the outcomes. RESULTS All 9 patients underwent POEM successfully. Mean operation time was 56.7minutes. Mean myotomy length was 8.3cm. Among them, 4 patients underwent circular myotomy and 5 underwent full-thickness myotomy. Symptoms remitted in all of the cases during a follow-up of 3-30months, Eckardt score was significantly reduced (preoperation vs postoperation, 7.0±1.9 vs 0.8±0.8, P<0.05). Mean LES pressure decreased from 26.8mm Hg to 9.1mm Hg. Mean diameter of esophagus was dramatically decreased (preoperation vs postoperation, 50.6±4.9mm vs 29.6±3.7mm, P<0.05). No serious complications related to POEM were encountered. CONCLUSIONS Our initial experience suggests that POEM is a safe and effective method for treatment of achalasia in children and adolescents. Further evaluation and long-term data are mandatory for a more confirmed conclusion.
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