Peroral Endoscopic Myotomy (POEM) in a 19-Month-Old Girl with Primary Achalasia

Abstract Introduction Primary achalasia is an idiopathic motility disorder of the esophagus characterized by esophageal aperistalsis and incomplete relaxation lower sphincter (LES) in response to swallowing. The gold standard diagnostic method adults high-resolution manometry (HRM). Diagnostic criteria are also used children, but some HRM normal values may change depending on age. Case Report A 15-month-old girl was admitted hospital for evaluation due persistent vomiting since birth. Vomiting included what she ate regardless amount food consumed. Barium esophagography revealed barium retention, dilatation, a “bird's beak appearance” distal esophagus. Esophagogastroduodenoscopy stenosis bubbles at esophagogastric junction. In HRM, resting LES pressure 43.4 mm Hg, there pan-esophageal pressurization with 60% swallows no peristalsis. patient diagnosed type II based Chicago 3.0 classification. First, tube inserted ensure adequate nutrition patient, approximately 4 months later, when 10 kg, peroral endoscopic myotomy (POEM) procedure performed. No complications developed during after procedure. At 6th month treatment, completely asymptomatic her weight within limits Conclusion POEM effective safe treatment pediatric patients achalasia.