Peroral endoscopic myotomy in children with achalasia: A review of the literature

Abstract

Achalasia is a rare esophageal motility disorder characterized by the inability of the lower esophageal sphincter (LES) to relax, accompanied by the loss of peristalsis in the esophageal body. Although more prevalent in adults, pediatric achalasia poses unique diagnostic challenges due to its atypical presentation. Peroral Endoscopic Myotomy (POEM) has emerged as a minimally invasive alternative to laparoscopic Heller myotomy for managing achalasia, particularly in children, but its efficacy and safety remain under-investigated. A comprehensive literature review was conducted to assess the role of POEM in pediatric achalasia, focusing on procedure efficacy, clinical outcomes, and safety. Key parameters included pre- and post-procedure Eckardt scores and adverse events. Comparison of outcomes with alternative interventions, such as laparoscopic myotomy and pneumatic dilation were also investigated. Currently, POEM achieves high clinical success in pediatric patients, with significant reduction in post-procedure Eckardt scores and LES pressures. Clinical success rates of up to 90% with durable symptom relief have been observed over follow-up exceeding one year. Common adverse events include mucosal injury, capnoperitoneum, and postoperative reflux. This comprehensive review reveals that POEM is as effective as laparoscopic myotomy but offers shorter hospital stay and reduced recovery time at the cost of a higher complication rate. POEM is an effective treatment for pediatric achalasia, providing durable symptom relief, comparable to traditional interventions. Future research should focus on the identification of pediatric patients that would benefit the most from POEM.

Keywords: Achalasia; Myotomy; Peroral endoscopic myotomy; Endoscopy; Pediatric achalasia

Core Tip: In pediatric patients with achalasia, peroral endoscopic myotomy (POEM) has shown high clinical success rates, achieving significant reduction in post-procedure symptoms and esophageal pressures. The current literature shows clinical success of up to 90% with durable symptom relief lasting over a year. Compared to traditional treatments, POEM offers shorter hospital stays and reduced recovery times at the cost of a higher complication rate. As the field continues to evolve, future research should focus on minimizing potential side effects and identifying children that will benefit the most from this procedure.