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

BACKGROUND: 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 6~17year-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 12months 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 36months 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.