Comparison of peroral endoscopic myotomy and endoscopic balloon dilation for primary treatment of pediatric achalasia

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• 作者：Yuyong Tan ; Hongyi Zhu ; Chenjie Li ; Yi Chu ; Jirong Huo ; Deliang Liu ; ^{liudeliang@medmail.com.cn" class="auth_mail" title="E-mail the corresponding author}
• 关键词：EBD ; Endoscopic balloon dilation ; POEM ; Peroral endoscopic myotomy ; HM ; Heller myotmy ; LES ; Lower esophageal sphincter ; EGD ; Esophagogastroduodenoscopy ; EGJ ; Esophagogastric junction
• 刊名：Journal of Pediatric Surgery
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：51
• 期：10
• 页码：1613-1618
• 全文大小：626 K

文摘

Both peroral endoscopic myotomy (POEM) and endoscopic balloon dilation (EBD) are effective method for pediatric achalasia, however little is known about the comparison between them. Herein we compare the safety and efficacy of them for primary treatment of pediatric achalasia.

Methods

We retrospectively reviewed the medical records of pediatric patients who received POEM or EBD for their primary therapy of achalasia at our hospital from January 2007 to June 2015, they were divided into the POEM group and EBD group. Demographics, and data about safety and efficacy were retrospectively collected and compared between the two groups.

Results

A total of 21 patients (Female/male: 11/10, aged 6 ~ 17 year-old) were enrolled, 12 of them received POEM, while the other 9 received EBD. As for the short-term efficacy, the treatment success (Eckardt score ≤ 3) rate of POEM and EBD 3, 6 and 12 months after the primary treatment were comparable (100% vs 100%, 100% vs 88.9%, 100% vs 66.7%, P > 0.05). As for the medium to long-term efficacy, the treatment success rate of POEM 24 and 36 months after the primary treatment was higher than that of EBD (100% vs 44.4%, 100% vs 33.3%, P < 0.05). Two cases in the POEM group suffered from esophagitis, and there was no significant difference between POEM and EBD (P > 0.05). No severe complications were observed during operation and periodical follow-up.

Conclusions

Short-term efficacy of POEM and EBD for primary treatment of pediatric achalasia was comparable, however POEM could result in a better intermediate and long-term efficacy. Large scale, randomized study is necessary for a confirmed conclusion.