Peroral endoscopic myotomy in pediatric achalasia ‒ A two-center retrospective cohort study with early feeding and early discharge.

BACKGROUND

achalasia is a rare esophageal motility disorder in children. The safety and efficacy of peroral endoscopic myotomy (POEM) in this population have already been demonstrated in multicenter studies. Here, we provide additional two-center real-world experience, with a particular focus on early feeding and early discharge, and also report outcomes in a small subgroup with triple-A syndrome.

METHODS

this retrospective cohort study included 21 patients younger than 18 years who underwent POEM between April 2023 and May 2025. Demographic, clinical, perioperative, and follow-up data were collected. Clinical success was defined as an Eckardt score ≤ 2 at three months. Secondary outcomes included technical success, changes in integrated relaxation pressure (IRP), perioperative and postoperative complications, length of hospital stay, and follow-up endoscopic findings.

RESULTS

the mean age was 13.0 years. Type II achalasia was the most common manometric subtype (67 %). All procedures were completed successfully with 100 % technical success. The mean duration of POEM was 58 minutes, and no major complications were observed. The most frequent complication was pneumoperitoneum (42.9 %), which required no additional intervention. Enteral feeding was initiated within 24 hours in 76 % of patients. Notably, nine patients (42 %) were discharged within 24 hours. At three months, clinical success was 100 % (95 % CI: 84.5-100). Pneumoperitoneum occurred in 42.9 % (95 % CI: 24.5-63.5). The mean reduction in IRP at three months (n = 12) was 23.2 mmHg (95 % CI: 20.0-26.3).

CONCLUSIONS

our two-center experience supports previous evidence of POEM's safety and efficacy in children. In addition, we provide new real-world insights into early feeding and shortened hospitalization.