Skip to main content

Advertisement

SpringerLink
Log in

Outcome of peroral endoscopic myotomy in children with achalasia

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background and aims

Achalasia cardia is rare in children and optimum endoscopic management options are not well known. Peroral endoscopic myotomy (POEM) is a novel treatment modality for achalasia with excellent results in adult patients. The long-term outcomes of POEM are not well known in children. In this study, we aim to evaluate the outcome of POEM in children with idiopathic achalasia.

Methods

We analyzed the data of children (≤ 18 years) diagnosed with achalasia from September 2013 to January 2018. Technical success, clinical success, and adverse events were assessed. Post-POEM, gastroesophageal reflux (GER) was assessed with 24-h pH-impedance study and esophagogastroduodenoscopy.

Results

A total of 44 children (boys—23, girls—21) with mean age of 14.5 ± 3.41 years (4–18) were diagnosed with achalasia during the study period. Of these, 43 children underwent POEM. The subtypes of achalasia according to Chicago classification were type I—11, type II—29, type III—2, and unclassified—2. Eighteen children (40.9%) had history of prior treatment. POEM was successfully performed in 43 children (technical success—97.72%). Intra-operative adverse events occurred in 11 (25.6%) children including retroperitoneal CO2 (7), capnoperitoneum (3), and mucosal injury (1). Clinical success at 1, 2, 3, and 4 years’ follow-up was 92.8%, 94.4%, 92.3%, and 83.3%, respectively. Erosive esophagitis was detected in 55% (11/20) children. On 24-h pH study, GER was detected in 53.8% (7/13) children.

Conclusion

POEM is a safe, effective, and durable treatment for achalasia in children. However, GER is a potential concern and should be evaluated in prospective studies before adopting POEM for the management of achalasia in children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Marlais M, Fishman JR, Fell JM, Haddad MJ, Rawat DJ (2011) UK incidence of achalasia: an 11 year national epidemiological study. Arch Dis Child 96:192–194

    Article  CAS  Google Scholar 

  2. Smits M, van Lennep M, Vrijlandt R, Benninga M, Oors J, Houwen R, Kokke F, van der Zee D, Escher J, van den Neucker A, de Meij T, Bodewes F, Schweizer J, Damen G, Busch O, van Wijk M (2016) Pediatric achalasia in the Netherlands: incidence, clinical course, and quality of life. J Pediatr 169:110–115.e113

    Article  Google Scholar 

  3. Hallal C, Kieling CO, Nunes DL, Ferreira CT, Peterson G, Barros SG, Arruda CA, Fraga JC, Goldani HA (2012) Diagnosis, misdiagnosis, and associated diseases of achalasia in children and adolescents: a twelve-year single center experience. Pediatr Surg Int 28:1211–1217

    Article  Google Scholar 

  4. Zagory JA, Golden JM, Demeter NE, Nguyen Y, Ford HR, Nguyen NX (2016) Heller myotomy is superior to balloon dilatation or botulinum injection in children with achalasia: a two-center review. J Laparoendosc Adv Surg Tech Part A 26:483–487

    Article  Google Scholar 

  5. Di Nardo G, Rossi P, Oliva S, Aloi M, Cozzi DA, Frediani S, Redler A, Mallardo S, Ferrari F, Cucchiara S (2012) Pneumatic balloon dilation in pediatric achalasia: efficacy and factors predicting outcome at a single tertiary pediatric gastroenterology center. Gastrointest Endosc 76:927–932

    Article  Google Scholar 

  6. Nabi Z, Ramchandani M, Chavan R, Kalapala R, Darisetty S, Rao GV, Reddy N (2017) Per-oral endoscopic myotomy for achalasia cardia: outcomes in over 400 consecutive patients. Endosc Int Open 5:E331–E339

    Article  Google Scholar 

  7. Nabi Z, Ramchandani M, Chavan R, Tandan M, Kalapala R, Darisetty S, Lakhtakia S, Rao GV, Reddy DN (2017) Peroral endoscopic myotomy in treatment-naive achalasia patients versus prior treatment failure cases. Endoscopy 50(04):358–370

    PubMed  Google Scholar 

  8. Nabi Z, Ramchandani M, Chavan R, Tandan M, Kalapala R, Darisetty S, Reddy DN (2018) Peroral endoscopic myotomy in children: first experience with a new triangular knife. J Pediatr Gastroenterol Nutr 66:43–47

    Article  Google Scholar 

  9. Nabi Z, Ramchandani M, Reddy DN, Darisetty S, Kotla R, Kalapala R, Chavan R (2016) Per oral endoscopic myotomy in children with achalasia cardia. J Neurogastroenterol Motil 22:613–619

    Article  Google Scholar 

  10. Chen WF, Li QL, Zhou PH, Yao LQ, Xu MD, Zhang YQ, Zhong YS, Ma LL, Qin WZ, Hu JW, Cai MY, He MJ, Cui Z (2015) Long-term outcomes of peroral endoscopic myotomy for achalasia in pediatric patients: a prospective, single-center study. Gastrointest Endosc 81:91–100

    Article  Google Scholar 

  11. Miao S, Wu J, Lu J, Wang Y, Tang Z, Zhou Y, Huang Z, Ying H, Zhou P (2018) Peroral endoscopic myotomy in children with achalasia: a relatively long-term single-center study. J Pediatr Gastroenterol Nutr 66:257–262

    Article  Google Scholar 

  12. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, Pandolfino JE, International High Resolution Manometry Working G (2015) The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 27:160–174

    Article  CAS  Google Scholar 

  13. Eckardt VF (2001) Clinical presentations and complications of achalasia. Gastrointest Endosc Clin N Am 11:281–292, vi

    Article  CAS  Google Scholar 

  14. Nabi Z, Ramchandani M, Reddy DN (2017) Per-oral endoscopic myotomy in a child with achalasia cardia. J Pediatr Gastroenterol Nutr 65(2):e44

    Article  Google Scholar 

  15. Ramchandani M, Nabi Z, Reddy DN, Talele R, Darisetty S, Kotla R, Chavan R, Tandan M (2018) Outcomes of anterior myotomy versus posterior myotomy during POEM: a randomized pilot study. Endosc Int Open 6::E190–E198

    Article  Google Scholar 

  16. Vandenplas Y, Rudolph CD, Di Lorenzo C, Hassall E, Liptak G, Mazur L, Sondheimer J, Staiano A, Thomson M, Veereman-Wauters G, Wenzl TG, Nutrition North American Society for Pediatric Gastroenterology H, Nutrition, European Society for Pediatric Gastroenterology H (2009) Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr 49:498–547

    Article  Google Scholar 

  17. Meyer A, Catto-Smith A, Crameri J, Simpson D, Alex G, Hardikar W, Cameron D, Oliver M (2017) Achalasia: outcome in children. J Gastroenterol Hepatol 32:395–400

    Article  Google Scholar 

  18. Pacilli M, Davenport M (2017) Results of laparoscopic Heller’s myotomy for achalasia in children: a systematic review of the literature. J Laparoendosc Adv Surg Tech Part A 27:82–90

    Article  Google Scholar 

  19. Ramchandani M, Nageshwar Reddy D, Nabi Z, Chouhan R, Bapaye A, Bhatia S, Mehta N, Dhawan P, Chaudhary A, Ghoshal U, Philip M, Neuhaus H, Deviere J, Inoue H (2018) Management of achalasia cardia: expert consensus statements. J Gastroenterol Hepatol. https://doi.org/10.1111/jgh.14097

    Article  PubMed  Google Scholar 

  20. Akintoye E, Kumar N, Obaitan I, Alayo QA, Thompson CC (2016) Peroral endoscopic myotomy: a meta-analysis. Endoscopy 48(12):1059–1068

    Article  Google Scholar 

  21. Nabi Z, Ramchandani M, Chavan R, Tandan M, Kalapala R, Darisetty S, Reddy DN (2017) Per-oral endoscopic myotomy in children—first experience with a new triangular knife. J Pediatr Gastroenterol Nutr 66(1):43–47

    Article  Google Scholar 

  22. Kethman WC, Thorson CM, Sinclair TJ, Berquist WE, Chao SD, Wall JK (2017) Initial experience with peroral endoscopic myotomy for treatment of achalasia in children. J Pediatr Surg 53(8):1532–1536

    Article  Google Scholar 

  23. Wu QN, Xu XY, Zhang XC, Xu MD, Zhang YQ, Chen WF, Cai MY, Qin WZ, Hu JW, Yao LQ, Li QL, Zhou PH (2017) Submucosal fibrosis in achalasia patients is a rare cause of aborted peroral endoscopic myotomy procedures. Endoscopy 49(8):736–744

    Article  Google Scholar 

  24. Nabi Z, Reddy DN, Ramchandani M (2018) Adverse events during and after per-oral endoscopic myotomy: prevention, diagnosis, and management. Gastrointest Endosc 87:4–17

    Article  Google Scholar 

  25. Caldaro T, Familiari P, Romeo EF, Gigante G, Marchese M, Contini AC, Federici di Abriola G, Cucchiara S, De Angelis P, Torroni F, Dall’Oglio L, Costamagna G (2015) Treatment of esophageal achalasia in children: today and tomorrow. J Pediatr Surg 50:726–730

    Article  Google Scholar 

  26. Li C, Tan Y, Wang X, Liu D (2015) Peroral endoscopic myotomy for treatment of achalasia in children and adolescents. J Pediatr Surg 50:201–205

    Article  Google Scholar 

  27. Tan Y, Zhu H, Li C, Chu Y, Huo J, Liu D (2016) Comparison of peroral endoscopic myotomy and endoscopic balloon dilation for primary treatment of pediatric achalasia. J Pediatr Surg 51:1613–1618

    Article  Google Scholar 

  28. van Lennep M, van Wijk MP, Omari TIM, Benninga MA, Singendonk MMJ (2018) Clinical management of pediatric achalasia. Expert Rev Gastroenterol Hepatol 12:391–404

    Article  Google Scholar 

  29. Veenstra BR, Goldberg RF, Bowers SP, Thomas M, Hinder RA, Smith CD (2016) Revisional surgery after failed esophagogastric myotomy for achalasia: successful esophageal preservation. Surg Endosc 30:1754–1761

    Article  Google Scholar 

  30. Oelschlager BK, Chang L, Pellegrini CA (2003) Improved outcome after extended gastric myotomy for achalasia. Arch Surg 138:490–495; discussion 495–497

    Article  Google Scholar 

  31. Li QL, Yao LQ, Xu XY, Zhu JY, Xu MD, Zhang YQ, Chen WF, Zhou PH (2016) Repeat peroral endoscopic myotomy: a salvage option for persistent/recurrent symptoms. Endoscopy 48:134–140

    PubMed  Google Scholar 

  32. Tyberg A, Seewald S, Sharaiha RZ, Martinez G, Desai AP, Kumta NA, Lambroza A, Sethi A, Reavis KM, DeRoche K, Gaidhane M, Talbot M, Saxena P, Zamarripa F, Barret M, Eleftheriadis N, Balassone V, Inoue H, Kahaleh M (2016) A multicenter international registry of redo per-oral endoscopic myotomy (POEM) after failed POEM. Gastrointest Endosc 85(6):1208–1211

    Article  Google Scholar 

  33. van Hoeij FB, Ponds FA, Werner Y, Sternbach JM, Fockens P, Bastiaansen BA, Smout AJ, Pandolfino JE, Rosch T, Bredenoord AJ (2017) Management of recurrent symptoms after per-oral endoscopic myotomy in achalasia. Gastrointest Endosc 87(1):95–101

    Article  Google Scholar 

  34. Jones EL, Meara MP, Schwartz JS, Hazey JW, Perry KA (2016) Gastroesophageal reflux symptoms do not correlate with objective pH testing after peroral endoscopic myotomy. Surg Endosc 30:947–952

    Article  Google Scholar 

  35. Repici A, Fuccio L, Maselli R, Mazza F, Correale L, Mandolesi D, Bellisario C, Sethi A, Kashab M, Rosch T, Hassan C (2017) Gastroesophageal reflux disease after per-oral endoscopic myotomy as compared with Heller’s myotomy with fundoplication: a systematic review with meta-analysis. Gastrointest Endosc 87(4):934–943.e18

    Article  Google Scholar 

  36. Kumbhari V, Familiari P, Bjerregaard NC, Pioche M, Jones E, Ko WJ, Hayee B, Cali A, Ngamruengphong S, Mion F, Hernaez R, Roman S, Tieu AH, El Zein M, Ajayi T, Haji A, Cho JY, Hazey J, Perry KA, Ponchon T, Kunda R, Costamagna G, Khashab MA (2017) Gastroesophageal reflux after peroral endoscopic myotomy: a multicenter case-control study. Endoscopy 49(7):634–642

    Article  Google Scholar 

  37. Tyberg A, Choi A, Gaidhane M, Kahaleh M (2018) Transoral incisional fundoplication for reflux after peroral endoscopic myotomy: a crucial addition to our arsenal. Endosc Int Open 6::E549–E552

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India

    Zaheer Nabi, Mohan Ramchandani, Radhika Chavan, Santosh Darisetty, Rakesh Kalapala, Upender Shava, Manu Tandan, Rama Kotla & D. Nageshwar Reddy

Authors
  1. Zaheer Nabi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohan Ramchandani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Radhika Chavan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Santosh Darisetty
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rakesh Kalapala
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Upender Shava
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Manu Tandan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rama Kotla
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. D. Nageshwar Reddy
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RC and US were involved in collection and interpretation of data; ZN, MR, DNR, SD, RK (Rama Kotla) were involved in performing the procedure and drafting and revision of the article; MT and RK (Rakesh Ralapala) were involved in the conception and revision of the article.

Corresponding author

Correspondence to Zaheer Nabi.

Ethics declarations

Disclosures

Zaheer Nabi, Mohan Ramchandani, Radhika Chavan, Santosh Darisetty, Rakesh Kalapala, Upender Shava, Manu Tandan, Rama Kotla, and D.Nageshwar Reddy have no conflicts of interest or financial ties to disclose.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nabi, Z., Ramchandani, M., Chavan, R. et al. Outcome of peroral endoscopic myotomy in children with achalasia. Surg Endosc 33, 3656–3664 (2019). https://doi.org/10.1007/s00464-018-06654-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-06654-1

Keywords

Search

Navigation