Safety and Efficacy of Peroral Endoscopic Myotomy for the Treatment of Achalasia in Children: A Large Multi-Center Study
27 Pages Posted: 16 Jan 2019More...
Background: Peroral endoscopic myotomy (POEM) has showed excellent results for the treatment of achalasia in adults, but studies of POEM for children are limited. In this study, we comprehensively analyzed outcomes of POEM in children and compared with those in adults in a large multi-center study.
Methods: Between August 2010 and December 2015, 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.
Findings: 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 26*5% 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).
Interpretation: POEM can be safely and effectively performed in children with achalasia. In addition, it produces a better clinical response during long-term follow-up compared with that in adults.
Funding: This study was supported by grants from the National Natural Science Foundation of China (81873552, 81470811, 81570595, and 81670483), 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), and the Project of Shanghai Municipal Commission of Health and Family Planning (SHDC12016203).
Declaration of Interest: All authors have none to declare.
Ethical Approval: This retrospective study was approved by the local ethics committee. Written informed consent was obtained before POEM from patients or their caretakers if patients were <16 years of age.
Keywords: POEM; achalasia; children; outcome
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