Pediatric achalasia and peroral endoscopic myotomy (POEM): Ten-year outcomes for 101 children at a single institution.

INTRODUCTION

Pediatric achalasia, characterized by impaired relaxation of the lower esophageal sphincter (LES) and abnormal esophageal peristalsis, remains a rare but increasingly recognized motility disorder. While laparoscopic Heller myotomy (LHM) has traditionally been the surgical treatment of choice, peroral endoscopic myotomy (POEM) has emerged as a promising minimally invasive alternative, demonstrating favorable safety profiles and efficacy. This study presents the largest single-institutional review of POEM outcomes in pediatric patients to date, including a significant subgroup of patients aged 10 years or younger, addressing a critical gap in the current literature.

METHODS

A retrospective analysis was conducted on all pediatric patients who underwent POEM at Children's National Hospital between July 2015 and March 2025. Data analyzed included patient demographics, prior interventions, perioperative details, pre- and post-operative Eckardt scores, complications, and follow-up outcomes. Statistical analysis utilized Stata Software, with continuous variables presented as mean ± standard deviation (SD) or median and categorical data as frequencies.

RESULTS

During the study period, 101 children (mean age 11.7 ± 3.99 years; range 2-19 years) underwent 110 POEM procedures. Type II achalasia was predominant (63.4%). Prior interventions included endoscopic treatments (34.7%) and prior surgeries (26.7%). Mean operative time was 92.5 ± 53.1 minutes. Intraoperative complications occurred in 36.7% of cases, primarily minor gas-related events. Major complications were rare (1.8%). Postoperatively, the mean length of stay was 1.7 ± 2.2 days, with median follow-up of 29 months. Clinical success (Eckardt score < 3) after initial POEM was achieved in 85.5% of patients, rising to 100% following additional interventions. Long-term complications included recurrent dysphagia (6.36%), GERD (10.9%), and redo POEM (8.18%). EndoFLIP measurements demonstrated effective intervention.

CONCLUSION

This largest reported single-institution study confirms that POEM is a safe, effective, and durable treatment for pediatric achalasia, demonstrating superior outcomes compared to LHM. Optimal management of pediatric achalasia requires.