2021 Volume 57 Issue 4 Pages 742-747
A 15-year-old girl with a one-year history of swallowing disturbance was referred to our institution. After several examinations, she was diagnosed as having esophageal achalasia. On the 14th day of hospitalization, dilatation was performed, but the outcome was poor. She was discharged on the 21st day of hospitalization after the introduction of tube feeding. After the patient’s examinations were completed, we decided on a laparoscopic Heller myotomy, but we found it difficult to wait for the patient to recover from severe psychological distress. Perioral endoscopic myotomy (POEM) was performed under general anesthesia at another institution two months after the initial treatment with the help of a gastroenterologist. During the POEM procedure, a 7-cm-long myotomy of the inner orbicularis muscle was performed through the submucosal tunnel created at the posterior wall of the esophagus. The postoperative course was uneventful, and the Eckardt score markedly decreased (from 6 to 0 points). She was discharged on the fourth postoperative day and showed an early return to normal swallowing without recurrence. In the treatment of pediatric esophageal achalasia, we should recognize that the effect of pneumatic balloon dilatation may be limited. Recently, POEM has been accepted as an effective alternative to a conventional laparoscopic approach in pediatric patients. However, regarding the actual POEM implementation for pediatric patients, close cooperation between pediatric surgeons and gastroenterologists is necessary.
