At our recent national meeting, Dr. Peter Kahrilas indicated that POEM (Per-oral Endoscopic Myotomy) was now the treatment of choice for most adults with achalasia (#NASPGAN19 Postgraduate Course -Part 3).
A Chone et al (JPGN 2019; 69: 523-7) provide recent multicenter retrospective data on POEM in the pediatric age group (mean age 14 years), n=117.
- Clinical success, defined as Eckardt score ≤3 during followup, was achieved in 90.6% of cases. The Eckardt score was >3 in 5 (4.3%) and data was missing in 6 (5.1%)
- Adverse events included 1 case with significant bleeding, 2 cases of aspiration pneumonia (related to anesthesia), 1 esopleural fistula (managed endoscopically), and 6 mild AEs (4 mucosomtomies, 2 subcutaneous emphysema)
Additional related blog posts:
- POEM for Achalasia in Children
- Poems in practice for achalasia
- Achalasia -Updated Epidemiology | gutsandgrowth
D Ley et al (JPGN 2019; 69: 528-32) provide retrospective data on 39 patients, median age 19 months, with refractory esophageal strictures which were treated with mitomycin C. The authors considered mitomycin C after a minimum of two previous dilatations.
- Etiology: The majority had strictures/stenosis associated with esophageal atresia (n=25) followed by caustic ingestion in 9.
- Number of stenosis: The majority (n=35) had a single stenosis.
- In 26 patients (67%), topical application of mitomycin C was considered a success based on a reduction in the number of dilatations. In this group, the number of dilatations dropped from 102 to 17 over a comparable period.
- 16 (41%) never required further dilatation following mitomycin C application
My take: This study provides some of the best evidence that mitomycin C may be helpful. Long-term followup and more studies are needed.
Related blog posts:
- Guidelines for Esophageal Atresia-Tracheoesophageal fistula
- Endoscopic Incisional Therapy for Esophageal Strictures
- Injecting Steroids for esophageal strictures -Does it work?
- Endoscopy Module -Postgraduate Course Notes
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