Introduction of the per-oral endoscopic myotomy technique to pediatric surgical practice

Per-oral Endoscopic Myotomy (POEM) is a transmural endoscopic surgical technique that is gaining widespread adoption in the management of adult achalasia. The endoscopic approach offers excellent access to the muscular wall of the esophagus enabling division of the abnormal circular fibers. The procedure offers the benefits of having no visible scars, preserving the outer longitudinal esophageal muscle fibers and avoiding a hiatal dissection. After extensive advanced endoscopy training sessions and IRB review, a POEM was successfully performed in a 16 yo female with achalasia. The POEM was performed without complication by a pediatric surgeon with an operative time of 184 min. The patient has had significant improvement in both dysphagia and regurgitation at 1 month. Advanced endoscopy is developing the capacity to treat what are currently considered surgical diseases including achalasia. As intraluminal, transmural, and transluminal endoscopic procedures evolve, pediatric surgeons will have to define their role in advanced endoscopy.