AUTHOR=Nabi Zaheer , Ramchandani Mohan , Basha Jahangeer , Goud Rajesh , Darisetty Santosh , Reddy Duvvur Nageshwar 

TITLE=POEM Is a Durable Treatment in Children and Adolescents With Achalasia Cardia

JOURNAL=Frontiers in Pediatrics

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2022.812201

DOI=10.3389/fped.2022.812201

ISSN=2296-2360

ABSTRACT=Background and aim: Per-oral endoscopic myotomy (POEM) is emerging as an effective treatment in pediatric achalasia. There is limited data on the long-term efficacy of POEM in children and adolescents with achalasia. In this study, we aim to evaluate the outcomes of POEM at ≥4-years follow-up.
Method: The data of consecutive children who underwent POEM (September 2013 to July 2021) and completed at least four years follow-up were analysed, retrospectively. The primary outcome was clinical success (Eckardt≤3) at ≥4-years follow-up. The secondary outcomes included the prevalence of gastroesophageal reflux disease (GERD) and predictors of recurrent symptoms (Eckardt≥2) after POEM.
Results: A total of 69 children underwent POEM for achalasia during the study period. Of these, 41 (59.4%) children completed ≥4-years [mean 68.5 months (range 48-94)] follow-up and 38 included in the final analysis. The subtypes of achalasia included type I (28.9%), type II (60.5%) and type III (2.6%). A history of prior treatment was present in 11 (28.9%). Clinical success was recorded in 36 (94.7%) patients who successfully underwent POEM. Recurrent symptoms (Eckardt ≥2) were noticed in 12 (31.6%) children at ≥4years. On multivariate analysis, there were no identifiable factors which predicted recurrent symptoms after POEM. Symptomatic GERD and erosive esophagitis were detected in 13.8%(4/29) and 57.1% (8/14) children, respectively.
Conclusion: POEM is a durable treatment modality for achalasia in pediatric population irrespective of the sub-type of achalasia and history of prior treatment.