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©The Author(s) 2023.
World J Gastroenterol. Jun 14, 2023; 29(22): 3497-3507
Published online Jun 14, 2023. doi: 10.3748/wjg.v29.i22.3497
Published online Jun 14, 2023. doi: 10.3748/wjg.v29.i22.3497
Table 1 General characteristics of the pediatric group and the control group
| Pediatric group (n = 48) | Control group (n = 1025) | P value | ||
| Sex, n (%) | ||||
| Male | 26 (54.2) | 469 (45.8) | 0.253 | |
| Female | 22 (45.8) | 556 (54.2) | ||
| Age, median (range), years | 16 (7-18) | 43 (19-65) | < 0.001 | |
| BMI, median (range), kg/m2 | 17.7 (11.2-26.8) | 20.9 (12.9-40.4) | < 0.001 | |
| Chicago classification, n (%) | n = 42, 87.5 | n = 1003, 97.8 | 0.928 | |
| Type I | 7 (16.7) | 156 (15.5) | ||
| Type II | 32 (76.2) | 787 (78.5) | ||
| Type III | 3 (7.1) | 60 (6.0) | ||
| Ling classification, n (%) | 0.076 | |||
| Ling I | 9 (18.8) | 189 (17.0) | ||
| Ling IIa | 17 (35.4) | 340 (30.6) | ||
| Ling IIb | 18 (37.5) | 249 (22.4) | ||
| Ling IIc | 4 (8.3) | 206 (18.5) | ||
| Ling III | 0 (0.0) | 41 (1.35) | ||
| Disease course, median (range), month | 17.5 (2-120) | 48 (1-540) | < 0.001 | |
| LES pressure, median (range), mmHg | n = 42, 87.5 | n = 1003, 97.8 | 0.214 | |
| 25.8 (8.4-65.9) | 24.5 (1-83.2) | |||
| Prior treatment | 0.210 | |||
| Patients without prior treatment, n (%) | 36 (75.0) | 842 (82.1) | ||
| Patients with prior treatment, n (%) | 12 (25.0) | 183 (17.9) | ||
| BTI | 4 (8.3) | 46 (4.5) | ||
| PBD | 5 (10.4) | 92 (9.0) | ||
| POEM | 1 (2.1) | 9 (0.9) | ||
| LHM | 0 (0.0) | 10 (1.0) | ||
| ESP | 0 (0.0) | 14 (1.4) | ||
| PBD + BTI | 1 (2.1) | 3 (0.3) | ||
| ESP + BTI | 1 (2.1) | 1 (0.1) | ||
| POEM + PBD | 0 (0.0) | 2 (0.2) | ||
| PBD + ESP | 0 (0.0) | 3 (0.3) | ||
| PBD + LHM | 0 (0.0) | 1 (0.1) | ||
| BTI + LHM | 0 (0.0) | 1 (0.1) | ||
| ESP + LHM | 0 (0.0) | 1 (0.1) | ||
Table 2 Procedure‑related characteristics and complications of pediatric group and control group, n (%)
| Pediatric group | Control group | P value | |||
| Technique success | 48 (100.0) | 1016 (99.1) | > 0.999 | ||
| Length of tunnel, mean (range), cm | 10.8 (7-14) | 11.2 (5-20) | 0.206 | ||
| Length of esophageal myotomy, mean (range), cm | 5.3 (1-9) | 5.2 (3-15) | 0.529 | ||
| Length of gastric myotomy, mean (range), cm | 1.9 (0-4) | 1.9 (0-4) | 0.648 | ||
| Types of myotomy | 0.458 | ||||
| Progressive full-thickness myotomy | 42 (87.5) | 792 (78.0) | |||
| Full-thickness muscle myotomy | 3 (6.3) | 98 (9.6) | |||
| Circular muscle myotomy | 1 (2.1) | 56 (5.5) | |||
| Others1 | 2 (4.2) | 70 (6.9) | |||
| Procedure time, mean (range), min | 43.9 (24-116) | 47.1 (14-160) | 0.394 | ||
| Complications | 7 (14.6) | 148 (14.6) | 0.997 | ||
| Mucosa injury | 3 (6.2) | 84 (8.3) | |||
| Gas-related adverse event | |||||
| Pneumothorax | 0 (0.0) | 3 (0.3) | |||
| Pneumoperitoneum | 2 (4.2) | 27 (2.7) | |||
| Subcutaneous emphysema | 2 (4.2) | 32 (3.2) | |||
| Pleural effusion | 0 (0.0) | 1 (0.1) | |||
| Bleeding | 0 (0.0) | 1 (0.1) | |||
Table 3 The long-term outcomes of per-oral endoscopic myotomy in pediatric patients
| Pre-POEM | Post-POEM | P value | |
| Eckardt score, mean (range) | 8.0 (4-11) | 1.1 (0-4) | < 0.001 |
| Dysphagia, mean ± SD | 2.8 ± 0.7 | 0.6 ± 0.7 | < 0.001 |
| Regurgitation, mean ± SD | 1.7 ± 0.8 | 0.1 ± 0.2 | < 0.001 |
| Chest pain, mean ± SD | 1.0 ± 0.9 | 0.4 ± 0.6 | < 0.001 |
| Weight loss, mean ± SD | 1.5 ± 1.2 | 0.0 ± 0.0 | < 0.001 |
| Urbach score, mean (range) | 12.8 (10-20) | 24.7 (18-30) | < 0.001 |
| Height, mean (range), cm | 163.7 (120-184) | 170.5 (159-185) | < 0.001 |
| Weight, mean (range), kg | 49.9 (22.2-82) | 64.3 (47-100) | < 0.001 |
| Number of months absent from school, mean (range), months | 3.3 (0.5-24) | 0.1 (0-1) | < 0.001 |
Table 4 The long-term outcomes of per-oral endoscopic myotomy in pediatric group and matched control group
| Pediatric group (n = 34) | Matched control group (n = 34) | P value | ||
| Follow-up time, median (range), years | 5.7 (2.6-10.6) | 6.0 (2.7-10.7) | 0.954 | |
| Pre-POEM, Eckardt score, mean (range) | 8.0 (4-11) | 7.9 (4-12) | 0.975 | |
| Post-POEM (3 mo), Eckardt score, mean (range) | 0.3 (0-3) | 0.3 (0-2) | 0.978 | |
| Post-POEM, Eckardt score, mean (range) | 1.1 (0-4) | 1.4 (0-3) | 0.088 | |
| Eckardt score1 (pre-post), mean (range) | 6.9 (2-10) | 6.4 (0-12) | 0.578 | |
| Pre-POEM BMI, median (range), kg/m2 | 17.7 (11.2-26.8) | 20.0 (16.4-28.7) | < 0.001 | |
| Post-POEM BMI, median (range), kg/m2 | 20.8 (15.8-29.5) | 24.0 (19.5-29.4) | < 0.001 | |
| BMI (Post-pre)2, median (range), kg/m2 | 3.7 (-1.7-13) | 3.5 (0.7-12.9) | 0.502 | |
| Pre-POEM, Urbach score, mean (range) | 12.8 (10-20) | 12.7 (10-20) | 0.842 | |
| Post-POEM, Urbach score, mean (range) | 24.7 (18-30) | 25.7 (17-33) | 0.221 | |
| Urbach score3 (pre-post), mean (range) | 11.9 (1-18) | 13.0 (4-23) | 0.254 | |
| Clinical success, n (%) | 33 (97.1) | 34 (100.0) | > 0.999 | |
| Clinical reflux evaluation | 6 (17.6) | 12 (35.3) | 0.099 | |
| Reflux esophagitis by gastroscopy | 2 (5.9) | 2 (5.9) | ||
| Symptomatic reflux | 4 (11.8) | 10 (29.4) | ||
- Citation: Bi YW, Lei X, Ru N, Li LS, Wang NJ, Zhang B, Yao Y, Linghu EQ, Chai NL. Per-oral endoscopic myotomy is safe and effective for pediatric patients with achalasia: A long-term follow-up study. World J Gastroenterol 2023; 29(22): 3497-3507
- URL: https://www.wjgnet.com/1007-9327/full/v29/i22/3497.htm
- DOI: https://dx.doi.org/10.3748/wjg.v29.i22.3497