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Outcomes of treatment of childhood achalasia

Constance W Lee1, David W Kays, Mike K Chen

  • 1Division of Pediatric Surgery, University of Florida College of Medicine, PO Box 100119, Gainesville, FL 32610, USA.

Journal of Pediatric Surgery
|July 13, 2010
PubMed

Insights

Heller myotomy is more effective for treating pediatric achalasia than esophageal dilation, leading to fewer recurrences and less need for further procedures. This surgical approach offers more durable outcomes for children and adolescents with achalasia.

Area of Science:

  • Pediatric Gastroenterology
  • Surgical Innovation
  • Esophageal Motility Disorders

Background:

  • Achalasia management in pediatric patients lacks a clear consensus.
  • This study examines endoscopic and surgical treatments for achalasia in children and adolescents.

Purpose of the Study:

  • To review a single institution's experience with endoscopic and surgical interventions for pediatric achalasia.
  • To compare the long-term outcomes of different treatment modalities.

Main Methods:

  • Retrospective review of medical records for children diagnosed with achalasia between 1978 and 2008.
  • Analysis of patient demographics, interventions (esophageal dilation vs. Heller myotomy), and procedural outcomes.
  • Evaluation of symptom recurrence and need for subsequent interventions.

Main Results:

  • Thirty-four pediatric patients with achalasia were analyzed; 18 underwent esophageal dilation (ED) and 16 underwent Heller myotomy (HM).
  • Symptom recurrence was significantly higher in the ED group (15/15) compared to the HM group (8/15; P < .01).
  • Additional interventions were required in 93% of ED cases versus 40% of HM cases (P < .01).

Conclusions:

  • Heller myotomy demonstrates superior long-term efficacy in pediatric achalasia management.
  • The surgical approach is associated with lower symptom recurrence and reduced need for re-intervention.
  • Heller myotomy is recommended as the preferred procedure for achalasia in children and adolescents.
Abstract

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