Treatment of esophageal achalasia in children: Today and tomorrow

Tamara Caldaro, Pietro Familiari, Erminia Francesca Romeo, Giovanni Gigante, Michele Marchese, Anna Chiara Iolanda Contini, Giovanni Federici Di Abriola, Salvatore Cucchiara, Paola De Angelis, Filippo Torroni, Luigi Dall'Oglio, Guido Costamagna

Research output: Contribution to journalArticle

Abstract

Background Esophageal achalasia (EA) is a rare esophageal motility disorder in children. Laparoscopic Heller myotomy (LHM) represents the treatment of choice in young patients. Peroral endoscopic myotomy (POEM) is becoming an alternative to LHM. The aim of this study is to evaluate the effectiveness, safety, and outcomes of POEM vs LHM in treatment of children with EA. Methods Data of pediatric patients with EA, who underwent LHM and POEM from February 2009 to December 2013 in two centers, were collected. Results Eighteen patients (9 male, mean age: 11.6 years; range: 2-17 years) were included. Nine patients (6 male, mean age: 10.7 years; range: 2-16 years) underwent LHM, and the other 9 (3 males, mean age: 12.2 years; range: 6-17 years) underwent POEM procedure. Mean operation time was shorter in POEM group compared with LHM group (62/149 minutes). Myotomy was longer in POEM group than in LHM group (11/7 cm). One major complication occurred after LHM (esophageal perforation). No clinical and manometric differences were observed between LHM and POEM in follow-up. The incidence of iatrogenic gastroesophageal reflux disease was low (1 patient in both groups). Conclusions Results of a midterm follow-up show that LHM and POEM are safe and effective treatments also in children. Besides, POEM is a mini-invasive technique with an inferior execution timing compared to LHM. A skilled endoscopic team is mandatory to perform this procedure.

Original languageEnglish
Pages (from-to)726-730
Number of pages5
JournalJournal of Pediatric Surgery
Volume50
Issue number5
DOIs
Publication statusPublished - May 1 2015

Keywords

  • esophageal achalasia
  • esophageal manometry
  • Heller myotomy
  • POEM

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

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  • Cite this

    Caldaro, T., Familiari, P., Romeo, E. F., Gigante, G., Marchese, M., Contini, A. C. I., Federici Di Abriola, G., Cucchiara, S., De Angelis, P., Torroni, F., Dall'Oglio, L., & Costamagna, G. (2015). Treatment of esophageal achalasia in children: Today and tomorrow. Journal of Pediatric Surgery, 50(5), 726-730. https://doi.org/10.1016/j.jpedsurg.2015.02.047