title: Long-term outcomes of peroral endoscopic myotomy for achalasia in pediatric patients: a prospective, single-center study.
abstract: BACKGROUND
  Peroral endoscopic myotomy (POEM) has been developed to provide a less-invasive myotomy for achalasia in adults but seldom has been used in pediatric patients.
  
  
  OBJECTIVE
  To evaluate the feasibility, safety, and efficacy of POEM for pediatric patients with achalasia.
  
  
  METHODS
  Single-center, prospective study.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  A total of 27 pediatric patients (mean age 13.8 years, range 6-17 years) with achalasia.
  The primary outcome was symptom relief during follow-up, defined as an Eckardt score of ≤3. Secondary outcomes were procedure-related adverse events, clinical reflux adverse events, and lower esophageal sphincter (LES) pressure on manometry before and after POEM.
  
  
  RESULTS
  A total of 26 cases (96.3%) underwent successful POEM. A submucosal tunnelling attempt failed in 1 case because of serious inflammation and adhesion. No serious adverse events related to POEM were encountered. During a mean follow-up period of 24.6 months (range 15-38 months), treatment success was achieved in all patients (mean score before vs after treatment 8.3 vs 0.7; P < .001). Mean LES pressure also decreased from a mean of 31.6 mm Hg to 12.9 mm Hg after POEM (P < .001). Five patients developed clinical reflux adverse events (19.2%).
  
  
  CONCLUSIONS
  Single center and lack of some objective evaluations.
  
  
  CONCLUSIONS
  This relatively long-term follow-up study adds to the evidence that POEM seems to be a promising new treatment for pediatric patients with achalasia, resulting in long-term symptom relief in all cases and without serious adverse events.
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Chen
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Quan-Lin
authors.initials: QL
authors.lastname: Li
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Ping-Hong
authors.initials: PH
authors.lastname: Zhou
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Li-Qing
authors.initials: LQ
authors.lastname: Yao
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Mei-Dong
authors.initials: MD
authors.lastname: Xu
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Yi-Qun
authors.initials: YQ
authors.lastname: Zhang
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Yun-Shi
authors.initials: YS
authors.lastname: Zhong
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Li-Li
authors.initials: LL
authors.lastname: Ma
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Wen-Zheng
authors.initials: WZ
authors.lastname: Qin
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Jian-Wei
authors.initials: JW
authors.lastname: Hu
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Ming-Yan
authors.initials: MY
authors.lastname: Cai
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Meng-Jiang
authors.initials: MJ
authors.lastname: He
authors.affiliation: Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Zhao
authors.initials: Z
authors.lastname: Cui
mesh_terms: D000293:Adolescent; D002648:Child; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery; D004931:Esophageal Achalasia / Q000150:complications / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005764:Gastroesophageal Reflux; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008365:Manometry; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome