Related Experiment Video
Updated: Mar 23, 2026
Robotic Myotomy and Partial Fundoplication for Achalasia
Published on: August 11, 2023
Per Oral Endoscopic Myotomy in Children with Achalasia Cardia
Zaheer Nabi1, Mohan Ramchandani1, D Nageshwar Reddy1
1Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
Insights
Per oral endoscopic myotomy (POEM) effectively treats pediatric achalasia, improving symptoms and esophageal function. This minimally invasive procedure offers a safe and beneficial option for children and adolescents with this rare motility disorder.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Endoscopic Procedures
Background:
- Achalasia cardia (AC) is a rare esophageal motility disorder in children, with limited established treatment guidelines.
- Per oral endoscopic myotomy (POEM) shows promise for achalasia management in adults, but its pediatric efficacy is unknown.
Purpose of the Study:
- To evaluate the safety and efficacy of POEM in pediatric patients diagnosed with achalasia cardia.
- To assess the impact of POEM on symptom resolution and objective esophageal function parameters in children.
Main Methods:
- Retrospective analysis of pediatric patients (<18 years) who underwent POEM.
- Assessment of symptoms using the Eckardt score and objective measures (manometry, barium swallow, endoscopy) pre- and post-procedure.
- Clinical success defined as an Eckardt score ≤ 3 at 1-year follow-up.
Main Results:
- POEM was performed on 15 children, with 10 completing 1-year follow-up.
- Significant reduction in LES pressure (36.64 to 15.65 mmHg) and Eckardt scores (7.32 to 1.74) post-POEM (P=0.001).
- Complete symptom resolution and improved barium emptying (63.70%) observed at 1 year, with median weight gain of 0.65 kg.
Conclusions:
- POEM is a safe and effective treatment for achalasia cardia in children and adolescents.
- The procedure leads to significant symptom improvement and enhanced esophageal function.
- Larger studies are needed to further confirm POEM's long-term efficacy in pediatric achalasia.
Background/Aims:
Achalasia cardia (AC) is a motility disorder, characterized by impaired lower esophageal sphincter relaxation and absence of esophageal peristalsis. AC is rare in children with unclear optimum management strategies. Per oral endoscopic myotomy (POEM) is a novel technique for management of achalasia with encouraging results in adult patients. The efficacy and safety of POEM is not known for pediatric AC. The aim of our study was to evaluate the safety and efficacy of POEM in children with achalasia cardia.
Methods:
The data of all children (< 18 years) who underwent POEM at our center was retrospectively analysed. Symptoms were analysed using a validated score (Eckardt score) at regular predefined intervals. Objective parameters including high-resolution manometry, timed barium swallow and esophagogastroduodenoscopy were assessed before the procedure and at 1-year follow-up. Clinical success was defined as an Eckardt score ≤ 3.
Results:
A total of 15 children underwent POEM during the specified period. Ten out of 15 (10/15) completed 1-year follow-up. Median operative time was 100 (38-240) minutes. Mean pre and post procedure LES pressure were 36.64 ± 11.08 mmHg and 15.65 ± 5.73 mmHg, respectively (P = 0.001). Mean Eckardt score before and after the POEM was 7.32 ± 1.42 and 1.74 ± 0.67, respectively (P = 0.001). Mean percentage improvement in barium emptying at 5 minutes was 63.70 ± 4.46%. All children had complete resolution of symptoms at 1 year. Median weight gain of children at 1 year was 0.65 kg (range, 0.0-4.6).
Conclusions:
POEM is safe and effective for children and adolescents with achalasia. Future trials with larger sample size are warranted to establish its efficacy in pediatric AC.
Related Concept Videos
01:26Esophageal Strictures-II: Clinical Features and Management
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
01:29Endoscopic Procedures I: Esophagogastroduodenoscopy
During an EGD, the endoscope can be used to:
01:26Endoscopic Procedures V: ERCP
Patient...
01:21Barrett Esophagus-II: Clinical Manifestations and Management
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
01:29Gastroesophageal Reflux Disease II: Clinical Features and Management
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...
01:30Esophageal Strictures-I: Introduction
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...