title: Per Oral Endoscopic Myotomy in Children with Achalasia Cardia.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
authors.forename: Zaheer
authors.initials: Z
authors.lastname: Nabi
authors.affiliation: Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
authors.forename: Mohan
authors.initials: M
authors.lastname: Ramchandani
authors.affiliation: Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
authors.forename: D Nageshwar
authors.initials: DN
authors.lastname: Reddy
authors.affiliation: Department of Anesthesiology, Asian Institute of Gastroenterology, Hyderabad, India.
authors.forename: Santosh
authors.initials: S
authors.lastname: Darisetty
authors.affiliation: Department of Anesthesiology, Asian Institute of Gastroenterology, Hyderabad, India.
authors.forename: Rama
authors.initials: R
authors.lastname: Kotla
authors.affiliation: Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kalapala
authors.affiliation: Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
authors.forename: Radhika
authors.initials: R
authors.lastname: Chavan
keywords: Achalasia cardia; Child; Endoscopic surgical procedure