title: Peroral endoscopic myotomy for treatment of achalasia in children and adolescents.
abstract: BACKGROUND
  Peroral endoscopic myotomy (POEM) is a novel endoscopic technique for treatment of achalasia (AC) and has shown exciting results in adults. However, little is known about the safety and efficacy of POEM in children and adolescents. Herein we report our preliminary results of POEM for children and adolescents with AC.
  
  
  METHODS
  POEM was performed in 9 consecutive patients with AC, whose age ranged from 10 to 17years. After submucosal injection, a submucosal tunnel was created. Endoscopic myotomy of muscle bundles was then achieved under direct vision. The mucosal entry was closed by several clips. A validated clinical symptom score (Eckardt score), LES pressure, esophageal diameters and procedure-related complications were used to evaluate the outcomes.
  
  
  RESULTS
  All 9 patients underwent POEM successfully. Mean operation time was 56.7minutes. Mean myotomy length was 8.3cm. Among them, 4 patients underwent circular myotomy and 5 underwent full-thickness myotomy. Symptoms remitted in all of the cases during a follow-up of 3-30months, Eckardt score was significantly reduced (preoperation vs postoperation, 7.0±1.9 vs 0.8±0.8, P<0.05). Mean LES pressure decreased from 26.8mm Hg to 9.1mm Hg. Mean diameter of esophagus was dramatically decreased (preoperation vs postoperation, 50.6±4.9mm vs 29.6±3.7mm, P<0.05). No serious complications related to POEM were encountered.
  
  
  CONCLUSIONS
  Our initial experience suggests that POEM is a safe and effective method for treatment of achalasia in children and adolescents. Further evaluation and long-term data are mandatory for a more confirmed conclusion.
authors.affiliation: Department of Gastroenterology, the Second Xiangya Hospital of Central South University, Changsha 410011, China.
authors.forename: Chenjie
authors.initials: C
authors.lastname: Li
authors.affiliation: Department of Gastroenterology, the Second Xiangya Hospital of Central South University, Changsha 410011, China.
authors.forename: Yuyong
authors.initials: Y
authors.lastname: Tan
authors.affiliation: Department of Gastroenterology, the Second Xiangya Hospital of Central South University, Changsha 410011, China.
authors.forename: Xuehong
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Gastroenterology, the Second Xiangya Hospital of Central South University, Changsha 410011, China. Electronic address: liudeliang@medmail.com.cn.
authors.forename: Deliang
authors.initials: D
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004931:Esophageal Achalasia / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008866:Microsurgery / Q000379:methods*; D009092:Mucous Membrane / Q000601:surgery; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Achalasia; Adolescent; Children; Peroral endoscopic myotomy