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Updated: Dec 25, 2025
Robotic Myotomy and Partial Fundoplication for Achalasia
Published on: August 11, 2023
Treating children with achalasia using per-oral endoscopic myotomy (POEM): Twenty-one cases in review
Lauren Sy Wood1, Julia M Chandler1, Katherine E Portelli2
1Department of General Surgery, Stanford University School of Medicine, Stanford, CA.
Insights
Per-oral endoscopic myotomy (POEM) is a safe and effective treatment for pediatric achalasia, showing significant symptom improvement. This study highlights POEM
Area of Science:
- Gastroenterology and Endoscopic Procedures
- Pediatric Surgery
- Esophageal Motility Disorders
Background:
- Achalasia is a rare esophageal motility disorder affecting children.
- Per-oral endoscopic myotomy (POEM) is a minimally invasive treatment gaining traction for achalasia.
- Limited data exists on POEM's efficacy and safety in pediatric populations.
Purpose of the Study:
- To evaluate the success and safety of POEM in children with achalasia.
- To characterize the learning curve and procedural outcomes of POEM in a pediatric cohort.
- To assess symptom relief and complication rates following POEM in pediatric patients.
Main Methods:
- A prospective cohort study involving pediatric patients (<18 years) who underwent POEM between 2014 and 2019.
- Primary outcome: achalasia symptom severity assessed by Eckardt score at one year (target ≤3).
- Secondary outcomes: procedure duration, intraoperative and postoperative complications, and reintervention rates.
Main Results:
- Twenty-one pediatric patients (median age 13 years) underwent POEM.
- 100% symptomatic relief at one year post-procedure, with significantly improved median Eckardt scores (7±2 to 1±2).
- Procedure duration showed a learning curve plateau. Minor intraoperative complications (capnoperitoneum, mucosotomy) were managed conservatively. Reinterventions included dilations, Heller myotomy, and repeat POEM.
Conclusions:
- POEM is a viable and safe treatment option for pediatric achalasia.
- The procedure demonstrates significant efficacy in improving symptoms and quality of life.
- Proficiency in POEM procedures increases with experience, with minimal complications in this pediatric cohort.
Background:
Per-oral endoscopic myotomy (POEM), a modern treatment for achalasia, has only recently emerged as an option for pediatric patients. Here we describe and characterize the success of POEM in children with achalasia.
Methods:
A single-institution prospective cohort study was performed of patients <18 years old who underwent POEM from 2014 to 2019. Main outcomes were success at one year (Eckardt ≤3), procedure duration, complications, reintervention.
Results:
The median age of patients (n = 21) was 13 years (range 2-17). Median procedure duration was 92 min (range 52-259) with case duration plateau of 87.4 min and learning rate of 15.5 cases. Intraoperative complications included capnoperitoneum requiring needle decompression and mucosotomy requiring additional clips. One patient experienced chest pain with small capnoperitoneum seen on chest radiography, and three patients had extraluminal carbon dioxide found incidentally on routine radiography. All were managed with observation. Pre- versus 1-month postprocedure Eckardt scores were significantly improved (7 ± 2 versus 1 ± 2, p < 0.0001, and median ± SD) with 100% symptomatic relief at one year. To achieve this, 13 patients required further dilation(s), one required laparoscopic Heller myotomy, and two required repeat POEM.
Conclusions:
POEM is a viable and safe treatment for pediatric patients with achalasia. We demonstrate improvement in symptoms and procedure proficiency with minimal intra- and postoperative complications.
Type Of Study:
Prospective cohort study.
Level Of Evidence:
Level II.
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