Per Oral Endoscopic Myotomy (POEM) for Pediatric Achalasia
Topic overview
Retrospective study of 43 pediatric achalasia patients (2015-2021) comparing POEM and laparoscopic Heller myotomy outcomes. POEM demonstrated feasibility as primary or revisional therapy with 43% intraoperative complications (mostly pneumothorax/pneumoperitoneum) requiring no reoperation, 13.5% recurrent dysphagia, and median 2-day hospital stay.
Key takeaways
- POEM achieved 100% symptom relief in pediatric achalasia with mean Eckardt score dropping from 6.73 to 0.6 postoperatively.
- Intraoperative complications (43%) including pneumothorax and mucosotomy did not require reoperation during index admission.
- Reintervention rate was 16.2% (5 balloon dilations, 1 repeat myotomy) with all patients ultimately achieving symptom control.
- POEM is effective as both primary therapy and salvage procedure after failed laparoscopic Heller myotomy in children.
- Type II achalasia (67.6%) was most common; POEM operative time averaged 138 minutes with 2-day median hospital stay.
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