How effective is POEM in children?
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- POEM in children shows 91% clinical efficacy with significant reduction in Eckardt scores, comparable to adult outcomes.
- Post-operative reflux occurs in ~15% of pediatric POEM cases, similar to adult rates, due to absence of anti-reflux procedure.
- Multi-center data (117 patients, 14 hospitals, 3 continents) demonstrates POEM is safe and effective in pediatric achalasia.
- POEM is approaching standard-of-care status in adults; pediatric surgeons should prepare to adopt this technique for children.
- Unlike Heller myotomy, POEM lacks fundoplication, making post-op reflux surveillance essential in pediatric patients.
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We've been working with the literature team from the Chilean Society of Pediatric Surgeons to hunt down articles relevant to pediatric surgery beyond JPS. With their help, we chose to highlight a few articles this month focused on the foregut. Alex Gibbons has an exciting article to share from the Journal of Pediatric Gastroenterology and Nutrition. So Todd, your dad is basically one of the fathers of surgical endoscopy, right? He did a lot of surgical endoscopy, yeah. So like you and surgical endoscopy are basically siblings. Um, so I'm sure you're already familiar with the peroral endoscopic myotomy, poem. Yes. What do you know about poem in children? Not much. There's only a few centers that have been doing it. I think the data is pretty early and preliminary at this point. This article was trying to kind of pull together on an international basis like 14 different hospitals across three different continents, looking at poem in children. Um, but basically uh they looked at total of 117 patients across these 14 different hospitals and they wanted to see if poem in children, if they could compare those results to what you see in adults. Basically they found that in children, poem is just as effective, they had about a 91% clinical efficacy in terms of significant decrease in the efert score, which is kind of a score that they use to measure achalasia symptoms. I mean they had about a 15% postop reflux incidence. So again, the main drawback to poem would be that unlike in a Heller myotomy, you don't have any kind of anti-reflux procedure with it. Um, so uh these patients can potentially develop reflux afterwards. But essentially the 90% efficacy and the 15% reflux afterwards are pretty similar to what we see in adults. So this study showed that poem is effective and safe in children as well. You know, I think that that this procedure has really become not only popular but almost approaching standard of care. I wouldn't say it's there yet, but it's heading in that direction and we don't see it that often in children, but I my guess is that this is something that is going to have to take place in the pediatric population more often. We're going to have to start learning this technique as the results are starting to look encouraging.