Treatment of esophageal achalasia in children: Today and tomorrow

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Author Spotlight: Cutting-Edge Robotic Heller Myotomy Protocol for Treatment of Achalasia
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Author Spotlight: Cutting-Edge Robotic Heller Myotomy Protocol for Treatment of Achalasia

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Tamara Caldaro1, Pietro Familiari2, Erminia Francesca Romeo1

  • 1Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy.

Journal of Pediatric Surgery
|March 19, 2015
PubMed

Insights

Peroral endoscopic myotomy (POEM) and Laparoscopic Heller myotomy (LHM) are safe and effective for treating pediatric esophageal achalasia. POEM offers a shorter operation time compared to LHM.

Area of Science:

  • Pediatric surgery
  • Gastroenterology
  • Minimally invasive procedures

Background:

  • Esophageal achalasia (EA) is a rare pediatric motility disorder.
  • Laparoscopic Heller myotomy (LHM) is the standard treatment.
  • Peroral endoscopic myotomy (POEM) is an emerging alternative.

Purpose of the Study:

  • To evaluate the effectiveness and safety of POEM versus LHM in children with EA.
  • To compare clinical and manometric outcomes between the two procedures.

Main Methods:

  • Retrospective data collection from two centers (Feb 2009 - Dec 2013).
  • Included 18 pediatric patients with EA (9 LHM, 9 POEM).
  • Compared operation time, myotomy length, complications, and follow-up outcomes.

Main Results:

  • POEM had a shorter mean operation time (62 min) than LHM (149 min).
  • POEM involved a longer myotomy (11 cm) than LHM (7 cm).
  • One major complication (esophageal perforation) occurred after LHM; no significant clinical/manometric differences or increased GERD were observed between groups at midterm follow-up.

Conclusions:

  • Both LHM and POEM are safe and effective for pediatric EA.
  • POEM is a minimally invasive option with faster execution.
  • Expertise of the endoscopic team is crucial for successful POEM procedures.
Abstract

Keywords:
Heller myotomyPOEMesophageal achalasiaesophageal manometry

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