Peroral Endoscopic Myotomy for Achalasia in Pediatric Patient: A Case Report

Abstract

The patient was a 11-year-old girl who started vomiting from about 8 years of age. Since postprandial vomiting persisted after 10 years of age, she was examined thoroughly. Delayed esophageal emptying of contrast medium was noted on esophagography, and the integrated relaxation pressure (IRP) of the lower esophageal sphincter was high (63.8 mmHg) on high-resolution manometry. On the basis of these findings, the patient was diagnosed as having esophageal achalasia. The preoperative Eckardt score was 6. We performed peroral endoscopic myotomy (POEM), a new treatment for esophageal achalasia that has had favorable outcomes in adults. A submucosal tunnel was prepared from the 5-o’clock direction of the esophageal body. The external longitudinal muscle layer was conserved, and a 16 cm incision was selectively made in the inner circular muscle. Here subjective symptoms rapidly disappeared after surgery, and her Eckardt score and IRP improved to 0 and 17.7 mmHg, respectively. A proton-pump inhibitor (PPI) was administered for one month after surgery. At 3 months after surgery, mild esophagitis of Los Angeles classification A was observed on upper digestive tract endoscopy, but regurgitation symptoms were absent and her overall condition was favorable with a body weight gain of 2 kg.