Multicenter Evaluation of Clinical Efficacy and Safety of Per-oral Endoscopic Myotomy in Children
Corresponding Author
Adrien Choné
Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon and Lyon University, Lyon, France
Address correspondence and reprint requests to Adrien Choné, MD, Endoscopy Unit-Digestive Disease Department, Pavillon L- Edouard Herriot Hospital, 69437 Lyon Cedex, France (e-mail: [email protected]).Search for more papers by this authorPietro Familiari
Endoscopia Digestiva Chirurgica, Policlinico A. Gemelli, Rome, Italy
Search for more papers by this authorBurkhard von Rahden
University of Wuerzburg, Würzburg, Bavaria, Germany
Search for more papers by this authorHaruhiro Inoue
University Research Center, Nohon University, Chiyoda-ku
Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
Search for more papers by this authorYuto Shimamura
University Research Center, Nohon University, Chiyoda-ku
Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
Search for more papers by this authorKanefumi Yamashita
Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukoka city, Japan
Search for more papers by this authorMouen A. Khashab
Gastroenterology and endoscopy, John Hopkins Hospital, Baltimore, USA
Search for more papers by this authorHinorari Shiwaku
Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukoka city, Japan
Search for more papers by this authorPeter V. Draganov
Division of gastroenterology, University of Florida, Gainesville, Florida, USA
Search for more papers by this authorLybil B. Mendoza Alvarez
Division of gastroenterology, University of Florida, Gainesville, Florida, USA
Search for more papers by this authorStanislas Chaussade
Gastroenterology, Cochin Hospital, Assistance publique des hôpitaux de Paris, Paris, France
Search for more papers by this authorMarcel Tantau
IRGH Prof. Dr. O. Fodor Cluj-Napoca, Cluj Napoca, Romania
Search for more papers by this authorMathew Abraham
Penn State Hershey Gastroenterology, Penn State Milton S. Hershey Medical Center, Pennsylvaniz, USA
Search for more papers by this authorJeffrey Marks
University Hospitals Cleveland Medical Center, Cleveland, USA
Search for more papers by this authorGabriel Arevalo
University Hospitals Cleveland Medical Center, Cleveland, USA
Search for more papers by this authorEduardo Albéniz
Gastroenterology Department, Endoscopy Unit, Complejo Hospitalario de Navarra, Navarrabiomed, Universidad Pública de Navarra, IdiSNa, Pamplona, Spain
Search for more papers by this authorFrancois Mion
Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon and Lyon University, Lyon, France
Search for more papers by this authorSabine Roman
Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon and Lyon University, Lyon, France
Search for more papers by this authorJérôme Rivory
Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon and Lyon University, Lyon, France
Search for more papers by this authorAlain Lachaux
Pediatric Gastroenterology, Hopital Femme Mère Enfant, Hospices civils de Lyon, Lyon
Search for more papers by this authorNicolas Benech
Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon and Lyon University, Lyon, France
Search for more papers by this authorFabien Subtil
Service de Biostatistique, Hospices Civils de Lyon, Lyon
Université de Lyon, Université Lyon 1, France
CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France
Search for more papers by this authorThierry Ponchon
Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon and Lyon University, Lyon, France
Search for more papers by this authorMaximilien Barret
Gastroenterology, Cochin Hospital, Assistance publique des hôpitaux de Paris, Paris, France
Search for more papers by this authorMathieu Pioche
Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon and Lyon University, Lyon, France
Search for more papers by this authorCorresponding Author
Adrien Choné
Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon and Lyon University, Lyon, France
Address correspondence and reprint requests to Adrien Choné, MD, Endoscopy Unit-Digestive Disease Department, Pavillon L- Edouard Herriot Hospital, 69437 Lyon Cedex, France (e-mail: [email protected]).Search for more papers by this authorPietro Familiari
Endoscopia Digestiva Chirurgica, Policlinico A. Gemelli, Rome, Italy
Search for more papers by this authorBurkhard von Rahden
University of Wuerzburg, Würzburg, Bavaria, Germany
Search for more papers by this authorHaruhiro Inoue
University Research Center, Nohon University, Chiyoda-ku
Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
Search for more papers by this authorYuto Shimamura
University Research Center, Nohon University, Chiyoda-ku
Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
Search for more papers by this authorKanefumi Yamashita
Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukoka city, Japan
Search for more papers by this authorMouen A. Khashab
Gastroenterology and endoscopy, John Hopkins Hospital, Baltimore, USA
Search for more papers by this authorHinorari Shiwaku
Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukoka city, Japan
Search for more papers by this authorPeter V. Draganov
Division of gastroenterology, University of Florida, Gainesville, Florida, USA
Search for more papers by this authorLybil B. Mendoza Alvarez
Division of gastroenterology, University of Florida, Gainesville, Florida, USA
Search for more papers by this authorStanislas Chaussade
Gastroenterology, Cochin Hospital, Assistance publique des hôpitaux de Paris, Paris, France
Search for more papers by this authorMarcel Tantau
IRGH Prof. Dr. O. Fodor Cluj-Napoca, Cluj Napoca, Romania
Search for more papers by this authorMathew Abraham
Penn State Hershey Gastroenterology, Penn State Milton S. Hershey Medical Center, Pennsylvaniz, USA
Search for more papers by this authorJeffrey Marks
University Hospitals Cleveland Medical Center, Cleveland, USA
Search for more papers by this authorGabriel Arevalo
University Hospitals Cleveland Medical Center, Cleveland, USA
Search for more papers by this authorEduardo Albéniz
Gastroenterology Department, Endoscopy Unit, Complejo Hospitalario de Navarra, Navarrabiomed, Universidad Pública de Navarra, IdiSNa, Pamplona, Spain
Search for more papers by this authorFrancois Mion
Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon and Lyon University, Lyon, France
Search for more papers by this authorSabine Roman
Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon and Lyon University, Lyon, France
Search for more papers by this authorJérôme Rivory
Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon and Lyon University, Lyon, France
Search for more papers by this authorAlain Lachaux
Pediatric Gastroenterology, Hopital Femme Mère Enfant, Hospices civils de Lyon, Lyon
Search for more papers by this authorNicolas Benech
Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon and Lyon University, Lyon, France
Search for more papers by this authorFabien Subtil
Service de Biostatistique, Hospices Civils de Lyon, Lyon
Université de Lyon, Université Lyon 1, France
CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France
Search for more papers by this authorThierry Ponchon
Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon and Lyon University, Lyon, France
Search for more papers by this authorMaximilien Barret
Gastroenterology, Cochin Hospital, Assistance publique des hôpitaux de Paris, Paris, France
Search for more papers by this authorMathieu Pioche
Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon and Lyon University, Lyon, France
Search for more papers by this authorThe authors report no conflicts of interest.
ABSTRACT
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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