Per- Oral Endoscopic Myotomy (POEM) for Children with Achalasia

Peroral endoscopic myotomy, or POEM, is currently the most successful realization of natural orifice transluminal endoscopic surgery (NOTES). The procedure is a treatment option for achalasia, a primary motility disorder of the esophagus caused by neuromuscular dysfunction at the esophagogastric junction. Achalasia though rare in both adult and pediatric populations has profound life-long morbidity. POEM has rapidly become an alternative surgical treatment option to laparoscopic Heller myotomy owing to its low complication rates and promising long-term outcomes. As more POEM programs are implemented in children’s hospitals, pediatric anesthesiologists will need to become familiar with this advanced endoscopic procedure in order to provide safe anesthesia. To date, no clear recommendations exist for anesthetic management of pediatric patients undergoing POEM and guidance is extrapolated from limited adult literature. The efficacy and safety of the POEM procedure have been demonstrated in a number of pediatric patients by reviewing the surgical literature. An understanding of the procedural steps, an awareness of known intraoperative complications, and a review of management strategies will help avoid rare but catastrophic adverse events.