Impact of prior treatment on long-term outcome of peroral endoscopic myotomy in pediatric achalasia

Abstract

Background and aimPeroral endoscopic myotomy (POEM) is emerging as an effective treatment for achalasia in children. Long-term outcomes of POEM and impact of prior treatment are not known in pediatric population. In this study, we aim to evaluate the long-term efficacy of POEM in children with achalasia. MethodsChildren (≤18 years) with achalasia who underwent POEM and completed at least 36 months of follow-up were included in the study. Long-term clinical success (Eckardt ≤3) was evaluated and compared between treatment naïve versus prior treated cases. ResultsA total of 53 children underwent POEM at our center during the study period. Of these, 17 children completed at least 3 years of follow-up and were included in the study. Eight children had prior treatment including pneumatic dilatation (6), Heller's myotomy (1) and both Heller's myotomy and pneumatic dilatation (1). POEM was successfully completed in all the children. Median procedure duration was 95.76 ± 47.98 min (38–240 min.). Long-term clinical success was found in 88.2% children. The mean follow-up was 55.06 ± 10.65 months (range 36–67 months). There was no significant difference in the success rate between treatment naïve and prior treatment failure cases. ConclusionPOEM is a safe, effective and durable treatment for achalasia in children. Prior treatment does not affect the outcomes of POEM in children. Type of studyRetrospective comparative study. Level of evidenceIII.