The patient is a two-year-old with a diagnosis of achalasia. Achalasia is a motility disorder of the esophagus, which typically presents with poor, or disjointed peristalsis of the body of the esophagus, with a tight lower esophageal sphincter, that does not normally relax. This causes swallowing difficulties and ultimately in this patient was causing regurgitation and weight loss. It is an unusual diagnosis in someone this young, but has been described in other cases. The approach to treating this involves a myotomy of the lower esophageal sphincter. We classically did that through a laparoscopic Heller myotomy with a fundoplication. That was done through multiple small laparoscopic incisions in the abdomen. In 2013, here at Stanford Children's Health, we performed the first POEM procedure in children and we've gone on to perform about 20 of these cases, ranging in ages from, now two years old, all the way up to eighteen. There are some technical limitations in doing this procedure on such a small child, including not being able to use an overtube, and other instruments that we typically use. But having had the experience of doing it in other relatively small children, we're confident that we'll be able to perform the procedure successfully.
Peroral Endoscopic Myotomy (POEM) — Dr. James Wall | Preview medical surgical videos
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The patient is a two-year-old with a diagnosis of achalasia. Achalasia is a motility disorder of the esophagus, which typically presents with poor, or disjointed peristalsis of the body of the esophagus, with a tight lower esophageal sphincter, that does not normally relax. This causes swallowing difficulties and ultimately in this patient was causing regurgitation and weight loss. It is an unusual diagnosis in someone this young, but has been described in other cases. The approach to treating this involves a myotomy of the lower esophageal sphincter. We classically did that through a laparoscopic Heller myotomy with a fundoplication. That was done through multiple small laparoscopic incisions in the abdomen. In 2013, here at Stanford Children's Health, we performed the first POEM procedure in children and we've gone on to perform about 20 of these cases, ranging in ages from, now two years old, all the way up to eighteen. There are some technical limitations in doing this procedure on such a small child, including not being able to use an overtube, and other instruments that we typically use. But having had the experience of doing it in other relatively small children, we're confident that we'll be able to perform the procedure successfully.
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