Clinical Characteristics and Long-Term Efficacy of Peroral Endoscopic Myotomy in Pediatric Achalasia.

Abstract

Background and aims: Pediatric achalasia and peroral endoscopic myotomy (POEM) are not well investigated. This study aimed to examine the clinical characteristics of pediatric achalasia and evaluate the long-term outcomes of POEM.

Methods: We conducted a multicenter study across 14 high-volume centers, comparing the clinical characteristics of children (aged < 18 years) diagnosed with achalasia to those of adults (aged < 65 years). The POEM procedures and outcomes were also compared between the two groups.

Results: Of the 3421 patients with achalasia, 50 (1.5%) were children. Compared with adults, children had a shorter period to diagnosis (1.0 vs. 3.4 years; p < 0.001) and were more likely to be severely underweight (body mass index: 17.8 vs. 20.9 kg/m²; p < 0.001). However, children exhibited less esophageal dilation (46.0% vs. 64.1%; p = 0.013) and higher lower esophageal sphincter pressure (37.3 vs. 29.9 mmHg; p = 0.002). Notably, a significant failure to thrive was not observed in the pediatric group. The POEM procedure time was shorter for children compared to adults (58.0 vs. 83.0 min; p < 0.001). Clinical success rates were not significant between the two groups. Over the 5-year follow-up period, children had a lower incidence of reflux esophagitis following POEM compared to adults (11.0% vs. 26.4%; p = 0.013).

Conclusions: Pediatric achalasia is rare and typically presents with early-stage manometric and esophagogastric features, along with severe systemic symptoms requiring an early diagnosis. POEM is a durable and effective treatment for pediatric achalasia, offering advantages such as shorter procedural times and a lower incidence of postprocedure reflux compared to adults.