IDDF2021-ABS-0057 Outcome of per-oral endoscopic myotomy in children and adolescents with achalasia cardia: a systematic review and meta-analysis

Abstract

<h3>Background</h3> Per-oral endoscopic myotomy (POEM) is an established treatment modality in adult patients with achalasia cardia. Emerging data suggest that POEM may be effective in pediatric cases as well. In this systematic review and meta-analysis, we aim to analyze the outcomes of POEM in children and adolescents with achalasia cardia. <h3>Methods</h3> A literature search was performed in Embase, PubMed, Cochrane database for studies pertaining to POEM in pediatric achalasia between Jan 2010 to March 2013. The primary objective of the study was a clinical success (Eckardt≤3). Secondary outcomes included technical success, post-POEM manometry parameters, adverse events and gastroesophageal reflux (GER) after POEM. <h3>Results</h3> A total of 16-studies including 467 children (254-boys, 13.4±3.6y) were included in the review. Sub-types of achalasia in nine studies (n=337) included type I (30.6%), II (63.8%) and III (5.6%). Prior treatment was recorded in 105 (24.4%) cases. Pooled rates of technical and clinical success were 97.1%(95% CI 94.7%-98.4%) and 94.2%(95% CI 91.5%-96.1%), respectively (IDDF2021-ABS-0057 Figure 1. Forest plot demonstrating clinical success). There was a significant reduction in mean Eckardt score: OR 6.8(95% CI 6.29-7.25; p&lt;0.001), lower esophageal sphincter pressures (LESP): OR 19.51(95% CI 17.63-21.40; p&lt;0.001) and integrated relaxation pressures: OR 19.44(95% CI 13.33-25.55; p&lt;0.001) after POEM (IDDF2021-ABS-0057 Figure 2. Forest plot demonstrating the effect of POEM on mean Eckardt scores; IDDF2021-ABS-0057 Figure 3. Forest plot demonstrating the effect of POEM on mean LESP). Pooled rate of overall adverse events was 18.4%(95% CI 11.1%-28.8%, <i>I²</i> 73), mucosal injury 7.5% (95% CI 4.2% -12.8%; <i>I</i>²27) and insufflation related events 11% (95% CI 5.3%-21.7%; <i>I²</i>75) (IDDF2021-ABS-0057 Figure 4. Forest plot demonstrating adverse events associated with POEM). Reflux esophagitis and symptomatic GER were evident in 22.6% (95% CI 15%-32.5%; <i>I²</i> 52) and was 13.6% (95% CI 10.4%-17.7%; <i>I</i>²0), respectively (IDDF2021-ABS-0057 Figure 5. Forest plot demonstrating reflux esophagitis after POEM). <h3>Conclusions</h3> POEM is an effective procedure in pediatric achalasia. Future studies are required to determine the durability of response and GER after POEM.