POEM shown as preferable first-line surgery for pediatric achalasia - Children's National

Peroral endoscopic myotomy (POEM) is a preferable first-line surgical intervention for pediatric esophageal achalasia, according to an analysis of 10-year outcomes for this procedure at Children's National Hospital.

The single institution study evaluated clinical efficacy, safety, complications and durability of symptom relief based on data from 101 children who underwent 110 POEM procedures for achalasia from 2015 to 2025. The study group also included the largest cohort of children 10-years-old or younger who had this procedure ever reported in scientific literature.

Why it matters

Achalasia is a rare condition in adults and even less common in children, occurring in only 0.1 per 100,000 children annually and an estimated prevalence of 10 per 100,000. The rarity of achalasia in children has historically made collecting statistically significant evidence about how best to treat it difficult. However, as one of the first children's hospitals in the country to offer POEM as the first-line treatment of these conditions in children, Children's National has collected enough data in the last decade to conduct robust analysis for the first time.

Chief of General and Thoracic Surgery Mikael Petrosyan, MD, MBA, and his co-authors write, "Our results highlight the significant institutional adoption of this minimally invasive technique as a primary therapeutic intervention for achalasia in children. This aligns with previous pediatric studies documenting an increasing preference for POEM over traditional surgical interventions such as laparoscopic Heller myotomy (LHM), owing to its favorable procedural attributes and comparable outcomes."

Additionally, the authors note, "Our institutional preference toward POEM clearly reflects both the accumulated expertise and documented advantages of POEM, including shorter hospital stays, reduced postoperative discomfort and superior or equivalent symptomatic outcomes."

The study includes outcomes for the largest number of children 10 years of age or younger to undergo POEM procedures, showing the procedure is feasible and becoming more accepted in younger and smaller-sized patients. The cohort of younger children is also noteworthy because it includes those with complex genetic conditions, including Down syndrome, Triple A syndrome, GMPPA-CDG, MIRAGE syndrome and Sotos syndrome.

The authors point out that the success of procedures for this subgroup "underscores the adaptability, broad applicability and robust safety profile" of POEM for these patients.

Children's National leads the way

Children's National is one of the only children's hospitals in the country to offer POEM for treatment of these conditions in children. Dr. Petrosyan and Timothy Kane, MD, director of the Thoracic and Foregut Program, combined perform more POEM surgeries than any other pediatric surgeons in the United States.

As the program with the most experience caring for and collaborating with this unique patient population, the doctors emphasize that surgical procedures are only one part of the puzzle. They write, "Optimal management of pediatric achalasia involves a multidisciplinary approach tailored to each patient's clinical scenario, with the goal to maximize symptom relief, minimize procedural complications and enhance long-term quality of life."

Read the full study, Pediatric Achalasia and Peroral Endoscopic Myotomy (POEM): Ten-Year Outcomes for 101 Children at a Single Institution, in the Journal of Pediatric Surgery.