TY - JOUR
T1 - Multicenter Evaluation of Clinical Efficacy and Safety of Per-oral Endoscopic Myotomy in Children
AU - Choné, Adrien
AU - Familiari, Pietro
AU - von Rahden, Burkhard
AU - Desai, Pankaj
AU - Inoue, Haruhiro
AU - Shimamura, Yuto
AU - Eleftheriadis, Nikos
AU - Yamashita, Kanefumi
AU - Khashab, Mouen A.
AU - Shiwaku, Hinorari
AU - Seewald, Stefan
AU - Draganov, Peter V.
AU - Alvarez, Lybil B.Mendoza
AU - Chaussade, Stanislas
AU - Tantau, Marcel
AU - Abraham, Mathew
AU - Marks, Jeffrey
AU - Arevalo, Gabriel
AU - Albéniz, Eduardo
AU - Mion, Francois
AU - Roman, Sabine
AU - Rivory, Jérôme
AU - Dubois, Rémi
AU - Lachaux, Alain
AU - Benech, Nicolas
AU - Subtil, Fabien
AU - Ponchon, Thierry
AU - Barret, Maximilien
AU - Pioche, Mathieu
PY - 2019/11/1
Y1 - 2019/11/1
N2 - OBJECTIVES: Per-oral endoscopic myotomy (POEM) is a recommended treatment modality for achalasia, but there is little published data for its use in children. The objective of the present study was to evaluate whether POEM is clinically effective and safe for children. METHODS: International multicenter retrospective study conducted in 14 tertiary centers that included consecutive children who underwent POEM between January 2012 and August 2018. Outcomes, such as clinical response were assessed whenever available. Adverse events and factors associated with clinical failure were also investigated. RESULTS: A total of 117 patients (mean ± SD age: 14.2 ± 3.7 years) underwent POEM for achalasia (type I, n = 36; type II n=66; type III, n=8). Among these, 30 (26%) were pretreated (botulinum injection and/or pneumatic dilatation). Mean ± SD baseline Eckardt score was 7.5 ± 2.0. Clinical success was achieved in 90.6% of cases (95%CI [83.8%;95.2%]) in the intention-to-treat analysis. The mean ± SD Eckardt score post-POEM was 0.9 ± 1.2 (P < 0.001). The mean duration of follow-up time 545 days (range: 100-1612). A total of 7 adverse events occurred (4 mucosotomies, 2 subcutaneous emphysema, 1 esopleural fistula). Gastroesophageal reflux symptoms were seen in 17 patients (15%); missing data for 10 patients (9%). There was a trend towards more frequent clinical failure in achalasia associated with genetic disorders (40% vs 8%, P = 0.069). CONCLUSIONS: POEM in pediatric patients appears to be effective and safe, although there was a trend towards more frequent clinical failure achalasia associated with genetic disorders. Further studies are needed to assess the long-term outcomes, especially the consequences of GERD.
AB - OBJECTIVES: Per-oral endoscopic myotomy (POEM) is a recommended treatment modality for achalasia, but there is little published data for its use in children. The objective of the present study was to evaluate whether POEM is clinically effective and safe for children. METHODS: International multicenter retrospective study conducted in 14 tertiary centers that included consecutive children who underwent POEM between January 2012 and August 2018. Outcomes, such as clinical response were assessed whenever available. Adverse events and factors associated with clinical failure were also investigated. RESULTS: A total of 117 patients (mean ± SD age: 14.2 ± 3.7 years) underwent POEM for achalasia (type I, n = 36; type II n=66; type III, n=8). Among these, 30 (26%) were pretreated (botulinum injection and/or pneumatic dilatation). Mean ± SD baseline Eckardt score was 7.5 ± 2.0. Clinical success was achieved in 90.6% of cases (95%CI [83.8%;95.2%]) in the intention-to-treat analysis. The mean ± SD Eckardt score post-POEM was 0.9 ± 1.2 (P < 0.001). The mean duration of follow-up time 545 days (range: 100-1612). A total of 7 adverse events occurred (4 mucosotomies, 2 subcutaneous emphysema, 1 esopleural fistula). Gastroesophageal reflux symptoms were seen in 17 patients (15%); missing data for 10 patients (9%). There was a trend towards more frequent clinical failure in achalasia associated with genetic disorders (40% vs 8%, P = 0.069). CONCLUSIONS: POEM in pediatric patients appears to be effective and safe, although there was a trend towards more frequent clinical failure achalasia associated with genetic disorders. Further studies are needed to assess the long-term outcomes, especially the consequences of GERD.
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U2 - 10.1097/MPG.0000000000002432
DO - 10.1097/MPG.0000000000002432
M3 - Article
C2 - 31259787
SN - 0277-2116
VL - 69
SP - 523
EP - 527
JO - Journal of pediatric gastroenterology and nutrition
JF - Journal of pediatric gastroenterology and nutrition
IS - 5
ER -