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Short-term safety and efficacy of peroral endoscopic myotomy for the treatment of achalasia in children

  • Original Article—Alimentary Tract
  • Published:
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Abstract

Background

Peroral endoscopic myotomy (POEM) has shown excellent results for the treatment of achalasia in adults, but studies for children are limited. The study was aimed to analyze outcomes of peroral endoscopic myotomy (POEM) in children and compared with those in adults in a large multi-center study.

Methods

Records of consecutive patients with achalasia who underwent POEM at three tertiary centers were reviewed. A total of 130 children were included in this study. The primary outcomes of perioperative outcomes and clinical follow-up data were analyzed.

Results

One child (0.8%) experienced technical failure. Five children (3.8%) had major adverse events, including one with pneumothorax requiring drainage, two with delayed mucosa barrier failure, one with readmission, and one with vital-sign instability. Both post-POEM Eckardt score and median LES pressure were significantly lower than their pre-POEM reference values in children (0.7 vs 7.4; 7.0 vs 27.1 mmHg; both P < 0.001). During a median follow-up time of 40 months, clinical reflux rate was 27.0% and clinical failure rates at 1, 3, and 5 years were 1.8%, 3.5%, and 4.4% for children. The technical failure, major adverse events, and postoperative clinical reflux were comparable between children and adults (all P > 0.05). Kaplan–Meier analysis showed that the risk of clinical failure was lower in children than adults (log-rank test, hazard ratio = 0.37, 95% confidence interval 0.15–0.91, P = 0.023).

Conclusions

POEM can be safely performed in children with achalasia, and produce a better clinical response during long-term follow-up compared with that in adults.

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Abbreviations

POEM:

Peroral endoscopic myotomy

LES:

Lower esophageal sphincter

mAEs:

Major adverse events

EGD:

Esophagogastroduodenoscopy

CO2 :

Carbon dioxide

ICU:

Intensive care unit

rePOEM:

Repeat POEM

References

  1. Liu Z, Zhang X, Zhang W, et al. Comprehensive evaluation of the learning curve for peroral endoscopic myotomy. Clin Gastroenterol Hepatol. 2018;16(1420–1426):e2.

    Google Scholar 

  2. Marlais M, Fishman JR, Fell JM, et al. UK incidence of achalasia: an 11-year national epidemiological study. Arch Dis Child. 2011;96:192–4.

    Article  CAS  Google Scholar 

  3. Mayberry JF, Mayell MJ. Epidemiological study of achalasia in children. Gut. 1988;29:90–3.

    Article  CAS  Google Scholar 

  4. Sato H, Yokomichi H, Takahashi K, et al. Epidemiological analysis of achalasia in Japan using a large-scale claims database. J Gastroenterol. 2019;54:621–7.

    Article  Google Scholar 

  5. Chen WF, Li QL, Zhou PH, et al. Long-term outcomes of peroral endoscopic myotomy for achalasia in pediatric patients: a prospective, single-center study. Gastrointest Endosc. 2015;81:91–100.

    Article  Google Scholar 

  6. Sato H, Takahashi K, Mizuno KI, et al. Esophageal motility disorders: new perspectives from high-resolution manometry and histopathology. J Gastroenterol. 2018;53:484–93.

    Article  Google Scholar 

  7. Kahrilas PJ, Katzka D, Richter JE. Clinical practice update: the use of per-oral endoscopic myotomy in achalasia: expert review and best practice advice from the AGA institute. Gastroenterology. 2017;153:1205–11.

    Article  Google Scholar 

  8. Miao S, Wu J, Lu J, et al. Peroral endoscopic myotomy in children with achalasia: a relatively long-term single-center study. J Pediatr Gastroenterol Nutr. 2018;66:257–62.

    Article  Google Scholar 

  9. Nabi Z, Ramchandani M, Reddy DN, et al. Per Oral endoscopic myotomy in children with achalasia cardia. J Neurogastroenterol Motil. 2016;22:613–9.

    Article  Google Scholar 

  10. Li C, Tan Y, Wang X, et al. Peroral endoscopic myotomy for treatment of achalasia in children and adolescents. J Pediatr Surg. 2015;50:201–5.

    Article  Google Scholar 

  11. Caldaro T, Familiari P, Romeo EF, et al. Treatment of esophageal achalasia in children: Today and tomorrow. J Pediatr Surg. 2015;50:726–30.

    Article  Google Scholar 

  12. Tan Y, Zhu H, Li C, et al. Comparison of peroral endoscopic myotomy and endoscopic balloon dilation for primary treatment of pediatric achalasia. J Pediatr Surg. 2016;51:1613–8.

    Article  Google Scholar 

  13. Zhang XC, Li QL, Huang Y, et al. Peroral endoscopic myotomy using the posterior approach in an 11-month-old girl with achalasia, severe malnutrition, and recurrent pneumonia. Endoscopy. 2015;47(Suppl 1):E480–E482. (UCTN).

    PubMed  Google Scholar 

  14. Ren Y, Tang X, Chen Y, et al. Pre-treatment Eckardt score is a simple factor for predicting one-year peroral endoscopic myotomy failure in patients with achalasia. Surg Endosc. 2017;31:3234–41.

    Article  Google Scholar 

  15. Li QL, Zhou PH. Perspective on peroral endoscopic myotomy for achalasia: Zhongshan experience. Gut Liver. 2015;9:152–8.

    Article  Google Scholar 

  16. Liu ZQ, Li QL, Chen WF, et al. The effect of prior treatment on clinical outcomes in patients with achalasia undergoing peroral endoscopic myotomy. Endoscopy. 2019;51:307–16.

    Article  CAS  Google Scholar 

  17. Wu QN, Xu XY, Zhang XC, et al. Submucosal fibrosis in achalasia patients is a rare cause of aborted peroral endoscopic myotomy procedures. Endoscopy. 2017;49:736–44.

    Article  Google Scholar 

  18. Zhang XC, Li QL, Xu MD, et al. Major perioperative adverse events of peroral endoscopic myotomy: a systematic 5-year analysis. Endoscopy. 2016;48:967–78.

    Article  Google Scholar 

  19. Jones R, Junghard O, Dent J, et al. Development of the GerdQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther. 2009;30:1030–8.

    Article  CAS  Google Scholar 

  20. Li QL, Wu QN, Zhang XC, et al. Outcomes of per-oral endoscopic myotomy for treatment of esophageal achalasia with a median follow-up of 49 months. Gastrointest Endosc. 2018;87(1405–1412):e3.

    Google Scholar 

  21. Hassall E, Israel D, Shepherd R, et al. Omeprazole for treatment of chronic erosive esophagitis in children: a multicenter study of efficacy, safety, tolerability and dose requirements International Pediatric Omeprazole Study Group. J Pediatr. 2000;137:800–7.

    Article  CAS  Google Scholar 

  22. Poddar U. Gastroesophageal reflux disease (GERD) in children. Paediatr Int Child Health. 2019;39:7–12.

    Article  Google Scholar 

  23. Nikaki K, Woodland P, Sifrim D. Adult and paediatric GERD: diagnosis, phenotypes and avoidance of excess treatments. Nat Rev Gastroenterol Hepatol. 2016;13:529–42.

    Article  Google Scholar 

  24. Hurwitz M, Bahar RJ, Ament ME, et al. Evaluation of the use of botulinum toxin in children with achalasia. J Pediatr Gastroenterol Nutr. 2000;30:509–14.

    Article  CAS  Google Scholar 

  25. Ip KS, Cameron DJ, Catto-Smith AG, et al. Botulinum toxin for achalasia in children. J Gastroenterol Hepatol. 2000;15:1100–4.

    Article  CAS  Google Scholar 

  26. Anselmino M, Perdikis G, Hinder RA, et al. Heller myotomy is superior to dilatation for the treatment of early achalasia. Arch Surg. 1997;132:233–40.

    Article  CAS  Google Scholar 

  27. Askegard-Giesmann JR, Grams JM, Hanna AM, et al. Minimally invasive Heller's myotomy in children: safe and effective. J Pediatr Surg. 2009;44:909–11.

    Article  Google Scholar 

  28. Corda L, Pacilli M, Clarke S, et al. Laparoscopic oesophageal cardiomyotomy without fundoplication in children with achalasia: a 10-year experience: a retrospective review of the results of laparoscopic oesophageal cardiomyotomy without an anti-reflux procedure in children with achalasia. Surg Endosc. 2010;24:40–4.

    Article  Google Scholar 

  29. Maselli R, Inoue H, Misawa M, et al. Peroral endoscopic myotomy (POEM) in a 3-year-old girl with severe growth retardation, achalasia, and Down syndrome. Endoscopy. 2012;44(Suppl 2):E285–E287287.

    PubMed  Google Scholar 

  30. Bechara R, Onimaru M, Ikeda H, et al. Per-oral endoscopic myotomy, 1000 cases later: pearls, pitfalls, and practical considerations. Gastrointest Endosc. 2016;84:330–8.

    Article  Google Scholar 

  31. Nabi Z, Ramchandani M, Chavan R, et al. Peroral endoscopic myotomy in treatment-naive achalasia patients versus prior treatment failure cases. Endoscopy. 2018;50:358–70.

    Article  Google Scholar 

  32. Ngamruengphong S, Inoue H, Ujiki MB, et al. Efficacy and safety of peroral endoscopic myotomy for treatment of achalasia after failed heller myotomy. Clin Gastroenterol Hepatol. 2017;15(1531–1537):e3.

    Google Scholar 

  33. Sherman RE, Anderson SA, Dal Pan GJ, et al. Real-world evidence—What Is It and What can it tell us? N Engl J Med. 2016;375:2293–7.

    Article  Google Scholar 

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Acknowledgements

All authors have none to declare.

Funding

This study was supported by grants from the National Natural Science Foundation of China (81873552, 81470811, 81570595, and 81670483), Shanghai Rising Star Program (19QA1401190), Major Project of Shanghai Municipal Science and Technology Committee (18ZR1406700, 16411950400, 16DZ2280900), Chen Guang Program of Shanghai Municipal Education Commission (15CG04), and Outstanding Young Doctor Training Project of Shanghai Municipal Commission of Health and Family Planning (2017YQ026), Xi'an hygiene and health commission, Key disciplines and dominant specialties program (2015038), and the Project of Shanghai Municipal Commission of Health and Family Planning (SHDC12016203).

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Authors and Affiliations

  1. Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, People’s Republic of China

    Zuqiang Liu, Yun Wang, Meidong Xu, Shiyao Chen, Weifeng Chen, Yunshi Zhong, Yiqun Zhang, Wenzheng Qin, Jianwei Hu, Mingyan Cai, Liqing Yao, Quanlin Li & Pinghong Zhou

  2. Department of Gastroenterology, The Children’s Hospital of Xi’an City, Xi’an, China

    Ying Fang, Hongbin Yang & Xiaoxia Ren

  3. Department of Gastroenterology, Children’s Hospital, Fudan University, Shanghai, China

    Ying Huang

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  1. Zuqiang Liu
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Contributions

Planning and conducting the study: Quanlin Li and Pinghong Zhou; Collecting data: Zuqiang Liu, Yun Wang, Ying Fang, Ying Huang, Hongbin Yang, Xiaoxia Ren, Meidong Xu, Shiyao Chen, Weifeng Chen, Yunshi Zhong, Yiqun Zhang, Wenzheng Qin, Jianwei Hu, Mingyan Cai, Liqing Yao; Analyzing and interpreting data: Zuqiang Liu, Yun Wang; Drafting manuscript: Zuqiang Liu, Quanlin Li; Final approval of manuscript: All authors.

Corresponding authors

Correspondence to Quanlin Li or Pinghong Zhou.

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Zuqiang Liu, Yun Wang, Ying Fang and Ying Huang shared co-first authorship.

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Liu, Z., Wang, Y., Fang, Y. et al. Short-term safety and efficacy of peroral endoscopic myotomy for the treatment of achalasia in children. J Gastroenterol 55, 159–168 (2020). https://doi.org/10.1007/s00535-019-01607-4

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  • DOI: https://doi.org/10.1007/s00535-019-01607-4

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