Outcomes of Peroral Endoscopic Myotomy (Poem) for Esophageal Achalasia in Patients Under 20 Years Old

Background Esophageal achalasia is a motility disorder characterized by impaired relaxation of the lower esophageal sphincter and loss of esophageal peristalsis. While the peak age of diagnosis is reported to be in the 40s to 50s, it can also occur during childhood, though diagnosis in pediatric cases is often challenging. This study aimed to evaluate the efficacy and safety of peroral endoscopic myotomy (POEM) for esophageal achalasia in patients aged 20 years and younger. Methods A total of 281 patients who underwent POEM at our institution between April 2015 and July 2024 were included in this study. The patients were divided into two groups: those under 20 years old and those 20 years and older. Their clinical backgrounds and treatment outcomes were compared and analyzed. Results The study included 8 patients under 20 years old (Y group) and 271 patients aged 20 and older (A group). The median age was 16.5 years (Y) and 58 years (A), with a median disease duration of 7.5 and 54 months, respectively (P < 0.05). Prior treatments included balloon dilation (Y: 4, A: 52), POEM (A: 1), and Heller-Dor (A: 7). The Eckardt score improved from 6.6 ± 2.3 to 0.6 ± 0.7 (Y) and 5.1 ± 2.1 to 0.5 ± 0.8 (A). One A-group patient required ICU admission due to anesthesia-related aspiration, with no other major complications. Conclusion Pediatric and adolescent patients with esophageal achalasia are reported to have a shorter disease duration than adults, a trend also observed in this study. However, despite the shorter duration, childhood and adolescence are critical periods for physical development, making early diagnosis and treatment essential. Feeding difficulties in these patients can negatively impact both physical and mental health, potentially hindering growth and learning opportunities. Therefore, prompt diagnosis and treatment are crucial to prevent long-term adverse effects on development and overall well-being. POEM for esophageal achalasia was safe and effective even in pediatric and adolescent cases.