title: Treatment of esophageal achalasia in children: Today and tomorrow.
abstract: BACKGROUND
  Esophageal achalasia (EA) is a rare esophageal motility disorder in children. Laparoscopic Heller myotomy (LHM) represents the treatment of choice in young patients. Peroral endoscopic myotomy (POEM) is becoming an alternative to LHM. The aim of this study is to evaluate the effectiveness, safety, and outcomes of POEM vs LHM in treatment of children with EA.
  
  
  METHODS
  Data of pediatric patients with EA, who underwent LHM and POEM from February 2009 to December 2013 in two centers, were collected.
  
  
  RESULTS
  Eighteen patients (9 male, mean age: 11.6 years; range: 2-17 years) were included. Nine patients (6 male, mean age: 10.7 years; range: 2-16 years) underwent LHM, and the other 9 (3 males, mean age: 12.2 years; range: 6-17 years) underwent POEM procedure. Mean operation time was shorter in POEM group compared with LHM group (62/149 minutes). Myotomy was longer in POEM group than in LHM group (11/7 cm). One major complication occurred after LHM (esophageal perforation). No clinical and manometric differences were observed between LHM and POEM in follow-up. The incidence of iatrogenic gastroesophageal reflux disease was low (1 patient in both groups).
  
  
  CONCLUSIONS
  Results of a midterm follow-up show that LHM and POEM are safe and effective treatments also in children. Besides, POEM is a mini-invasive technique with an inferior execution timing compared to LHM. A skilled endoscopic team is mandatory to perform this procedure.
authors.affiliation: Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy. Electronic address: tamara.caldaro@opbg.net.
authors.forename: Tamara
authors.initials: T
authors.lastname: Caldaro
authors.affiliation: Digestive Surgery and Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Familiari
authors.affiliation: Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Erminia Francesca
authors.initials: EF
authors.lastname: Romeo
authors.affiliation: Digestive Surgery and Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gigante
authors.affiliation: Digestive Surgery and Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Marchese
authors.affiliation: Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Anna Chiara Iolanda
authors.initials: AC
authors.lastname: Contini
authors.affiliation: Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Federici di Abriola
authors.affiliation: Pediatric Gastroenterology and Liver Unit, Sapienza University, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cucchiara
authors.affiliation: Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: De Angelis
authors.affiliation: Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Torroni
authors.affiliation: Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Dall'Oglio
authors.affiliation: Digestive Surgery and Endoscopy Unit, Catholic University, Rome, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008365:Manometry; D061646:Operative Time; D016896:Treatment Outcome
keywords: Heller myotomy; POEM; esophageal achalasia; esophageal manometry