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Safety and Efficacy of Peroral Endoscopic Myotomy for the Treatment of Achalasia in Children: A Large Multi-Center Study

27 Pages Posted: 16 Jan 2019

See all articles by Zuqiang Liu

Zuqiang Liu

Fudan University

Yun Wang

Fudan University

Ying Fang

Children’s Hospital of Xi'an City

Ying Huang

Fudan University

Hongbin Yang

Children’s Hospital of Xi'an City

Meidong Xu

Fudan University

Shiyao Chen

Fudan University

Weifeng Chen

Fudan University

Yunshi Zhong

Fudan University

Yiqun Zhang

Fudan University

Wenzheng Qin

Fudan University

Jianwei Hu

Fudan University

Mingyan Cai

Fudan University

Liqing Yao

Fudan University

Ping-Hong Zhou

Fudan University - Endoscopy Center and Endoscopy Research Institute

Quan-Lin Li

Fudan University - Endoscopy Center and Endoscopy Research Institute

More...

Abstract

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

Suggested Citation

Liu, Zuqiang and Wang, Yun and Fang, Ying and Huang, Ying and Yang, Hongbin and Xu, Meidong and Chen, Shiyao and Chen, Weifeng and Zhong, Yunshi and Zhang, Yiqun and Qin, Wenzheng and Hu, Jianwei and Cai, Mingyan and Yao, Liqing and Zhou, Ping-Hong and Li, Quan-Lin, Safety and Efficacy of Peroral Endoscopic Myotomy for the Treatment of Achalasia in Children: A Large Multi-Center Study (June 1, 2019). Available at SSRN: https://ssrn.com/abstract=3314444

Zuqiang Liu

Fudan University

Beijing West District Baiyun Load 10th
Shanghai, 100045
China

Yun Wang

Fudan University

Beijing West District Baiyun Load 10th
Shanghai, 100045
China

Ying Fang

Children’s Hospital of Xi'an City

Xi’an
China

Ying Huang

Fudan University

Beijing West District Baiyun Load 10th
Shanghai, 100045
China

Hongbin Yang

Children’s Hospital of Xi'an City

Xi’an
China

Meidong Xu

Fudan University

Beijing West District Baiyun Load 10th
Shanghai, 100045
China

Shiyao Chen

Fudan University

Beijing West District Baiyun Load 10th
Shanghai, 100045
China

Weifeng Chen

Fudan University

Beijing West District Baiyun Load 10th
Shanghai, 100045
China

Yunshi Zhong

Fudan University

Beijing West District Baiyun Load 10th
Shanghai, 100045
China

Yiqun Zhang

Fudan University

Beijing West District Baiyun Load 10th
Shanghai, 100045
China

Wenzheng Qin

Fudan University

Beijing West District Baiyun Load 10th
Shanghai, 100045
China

Jianwei Hu

Fudan University

Beijing West District Baiyun Load 10th
Shanghai, 100045
China

Mingyan Cai

Fudan University

Beijing West District Baiyun Load 10th
Shanghai, 100045
China

Liqing Yao

Fudan University

Beijing West District Baiyun Load 10th
Shanghai, 100045
China

Ping-Hong Zhou (Contact Author)

Fudan University - Endoscopy Center and Endoscopy Research Institute ( email )

180 FengLin Road
Shanghai, 200032
China

Quan-Lin Li

Fudan University - Endoscopy Center and Endoscopy Research Institute ( email )

180 FengLin Road
Shanghai, 200032
China

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