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

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.