Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2023; 29(22): 3497-3507
Published online Jun 14, 2023. doi: 10.3748/wjg.v29.i22.3497
Per-oral endoscopic myotomy is safe and effective for pediatric patients with achalasia: A long-term follow-up study
Ya-Wei Bi, Xiao Lei, Nan Ru, Long-Song Li, Nan-Jun Wang, Bo Zhang, Yi Yao, En-Qiang Linghu, Ning-Li Chai
Ya-Wei Bi, Nan Ru, Long-Song Li, Nan-Jun Wang, Bo Zhang, Yi Yao, En-Qiang Linghu, Ning-Li Chai, Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
Xiao Lei, Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing 100859, China
Author contributions: Bi YW, Lei X and Ru N contributed equally to this article; Bi YW, Lei X, Linghu EQ and Chai NL contributed to this paper with conception and design of the study; Bi YW, Lei X, Ru N, Li LS, Wang NJ, Zhang B and Yao Y did the data collection, literature review and analysis; Bi YW, Lei X and Ru N wrote the paper; all authors made the critical revision and editing of the article for important intellectual content, and approved the final version.
Supported by National Natural Science Foundation of China, No. 82070682.
Institutional review board statement: The study was reviewed and approved by the First Medical Center of Chinese PLA General Hospital Institutional Review Board, No. 20230301.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ning-Li Chai, MD, Chief Physician, Professor, Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. chainingli@vip.163.com
Received: May 8, 2023
Peer-review started: May 8, 2023
First decision: May 11, 2023
Revised: May 12, 2023
Accepted: May 19, 2023
Article in press: May 19, 2023
Published online: June 14, 2023
Abstract
BACKGROUND

Per-oral endoscopic myotomy (POEM) is emerging as a prefer treatment option for pediatric achalasia. However, data are limited on the long-term efficacy of POEM in children and adolescents with achalasia.

AIM

To evaluate the safety and long-term efficacy of POEM for pediatric patients with achalasia and compare those outcomes with adult patients.

METHODS

This retrospective cohort study was conducted in patients with achalasia who underwent POEM. Patients aged under 18 years were included in the pediatric group; patients aged between 18 to 65 years who underwent POEM in the same period were assigned to the control group. For investigation of long-term follow-up, the pediatric group were matched with patients from the control group in a 1:1 ratio. The procedure-related parameters, adverse events, clinical success, gastroesophageal reflux disease (GERD) after POEM, and quality of life (QoL) were evaluated.

RESULTS

From January 2012 to March 2020, POEM was performed in 1025 patients aged under 65 years old (48 in the pediatric group, 1025 in the control group). No significant differences were observed in the occurrence of POEM complications between the two groups (14.6% vs 14.6%; P = 0.99). Among the 34 pediatric patients (70.8%) who underwent follow-up for 5.7 years (range 2.6-10.6 years), clinical success was achieved in 35 patients (35/36; 97.2%). No differences were observed in post-POEM GERD occurrence (17.6% vs 35.3%; P = 0.10). QoL was significantly improved in both groups after POEM.

CONCLUSION

POEM is safe and effective for pediatric patients with achalasia. It can achieve significant symptoms relief and improve QoL.

Keywords: Achalasia, Pediatric, Per-oral endoscopic myotomy, Long-term outcomes

Core Tip: Per-oral endoscopic myotomy (POEM) is widely accepted in adult patients with achalasia. However, there is limited data on the application of POEM in pediatric patients, particularly regarding the long-term outcomes. In this study, we evaluated the safety and long-term efficacy of POEM in pediatric patients and compared those results with adult patients. The results show that POEM is safe and effective for pediatric patients with achalasia.