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CC BY 4.0 · Journal of Digestive Endoscopy 2023; 14(02): 112-114
DOI: 10.1055/s-0043-1769926
Case Report

Peroral Endoscopic Myotomy (POEM) in a 19-Month-Old Girl with Primary Achalasia

Serkan Duman 
1   Department of Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
,
Alper Yurci
2   Department of Gastroenterology, Erciyes University Faculty of Medicine, Kayseri, Turkey
,
Joo Young Cho 
3   Department of Gastroenterology, Cha University School of Medicine, Seoul, South Korea
› Author Affiliations Funding No specific funding has been received.
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Abstract

Introduction Primary achalasia is an idiopathic motility disorder of the esophagus characterized by esophageal aperistalsis and incomplete relaxation of the lower esophageal sphincter (LES) in response to swallowing. The gold standard diagnostic method in adults is high-resolution manometry (HRM). Diagnostic criteria in adults are also used in children, but some HRM normal values may change depending on age.

Case Report A 15-month-old girl was admitted to the hospital for evaluation due to persistent vomiting since birth. Vomiting included what she ate regardless of the amount of food she consumed. Barium esophagography revealed barium retention, esophageal dilatation, and a “bird's beak appearance” in the distal esophagus. Esophagogastroduodenoscopy revealed stenosis in the lower esophagus and bubbles at the esophagogastric junction.

In HRM, the resting LES pressure was 43.4 mm Hg, there was pan-esophageal pressurization with 60% of swallows and no normal peristalsis. The patient was diagnosed with type II achalasia based on the Chicago 3.0 classification.

First, the tube was inserted to ensure adequate nutrition of the patient, and approximately 4 months later, when the patient was 10 kg, the peroral endoscopic myotomy (POEM) procedure was performed.

No complications developed during and after the procedure. At the 6th month after treatment, the patient was completely asymptomatic and her weight was within normal limits for her age.

Conclusion POEM is an effective and safe method in the treatment of pediatric patients with idiopathic achalasia.

Keywords

achalasia - child - pediatrics - POEM


Publication History

Article published online:
22 June 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Patel DA, Kim HP, Zifodya JS, Vaezi MF. Idiopathic (primary) achalasia: a review. Orphanet J Rare Dis 2015; 10: 89
    CrossrefPubMedSearch in Google Scholar
  • 2 Boeckxstaens GE, Zaninotto G, Richter JE. Achalasia. Lancet 2014; 383 (9911): 83-93
    CrossrefPubMedSearch in Google Scholar
  • 3 Lee CW, Kays DW, Chen MK, Islam S. Outcomes of treatment of childhood achalasia. J Pediatr Surg 2010; 45 (06) 1173-1177
    CrossrefPubMedSearch in Google Scholar
  • 4 van Lennep M, van Wijk MP, Omari TIM, Benninga MA, Singendonk MMJ. Clinical management of pediatric achalasia. Expert Rev Gastroenterol Hepatol 2018; 12 (04) 391-404
    CrossrefPubMedSearch in Google Scholar
  • 5 Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol 2013; 108 (08) 1238-1249 , quiz 1250
    CrossrefPubMedSearch in Google Scholar
  • 6 Zhang XC, Li QL, Huang Y, Miao SJ, Zhou PH. Peroral endoscopic myotomy using the posterior approach in an 11-month-old girl with achalasia, severe malnutrition, and recurrent pneumonia. Endoscopy 2015; 47 (Suppl 1 UCTN): E480-E482
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Saez J, Mejia R, Pattillo JC. et al. Per oral endoscopic myotomy (POEM) in pediatric patients with esophageal achalasia: first Latin-American experience. J Pediatr Surg 2021; 56 (04) 706-710
    CrossrefPubMedSearch in Google Scholar
  • 8 Di Nardo G, Rossi P, Oliva S. et al. Pneumatic balloon dilation in pediatric achalasia: efficacy and factors predicting outcome at a single tertiary pediatric gastroenterology center. Gastrointest Endosc 2012; 76 (05) 927-932
    CrossrefPubMedSearch in Google Scholar
  • 9 Tashiro J, Petrosyan M, Kane TD. Current management of pediatric achalasia. Transl Gastroenterol Hepatol 2021; 6: 33
    CrossrefPubMedSearch in Google Scholar
  • 10 Inoue H, Minami H, Kobayashi Y. et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010; 42 (04) 265-271
    Thieme ConnectPubMedSearch in Google Scholar
  • 11 Caldaro T, Familiari P, Romeo EF. et al. Treatment of esophageal achalasia in children: today and tomorrow. J Pediatr Surg 2015; 50 (05) 726-730
    CrossrefPubMedSearch in Google Scholar
  • 12 Inoue H, Kudo S-E. Per-oral endoscopic myotomy (POEM) for 43 consecutive cases of esophageal achalasia [in Japanese]. Jpn J Clin Med 2010; 68 (09) 1749-1752
    Search in Google Scholar
  • 13 Talukdar R, Inoue H, Nageshwar Reddy D. Efficacy of peroral endoscopic myotomy (POEM) in the treatment of achalasia: a systematic review and meta-analysis. Surg Endosc 2015; 29 (11) 3030-3046
    CrossrefPubMedSearch in Google Scholar
  • 14 Li QL, Wu QN, Zhang XC. et al. Outcomes of per-oral endoscopic myotomy for treatment of esophageal achalasia with a median follow-up of 49 months. Gastrointest Endosc 2018; 87 (06) 1405-1412.e3
    CrossrefPubMedSearch in Google Scholar
  • 15 Nabi Z, Ramchandani M, Basha J, Goud R, Darisetty S, Reddy DN. POEM is a durable treatment in children and adolescents with achalasia cardia. Front Pediatr 2022; 10: 812201
    CrossrefPubMedSearch in Google Scholar