POEM for childhood achalasia: is it safe and effective?
When a child struggles to swallow and is diagnosed with achalasia, families always ask the same thing: is there a treatment that works and is safe? Let's look at the data.
POEM is an endoscopic technique with no cuts on the skin to treat achalasia.
TL;DR (quick summary)
Does it work?
- • Yes: clinical success of 88–95% in children.
- • The benefit lasts 4–5 years or more in most.
Is it safe?
- • In general yes; complications usually resolve without reoperation.
- • The main thing to watch is reflux, with follow-up.
POEM for childhood achalasia is today one of the best options to treat a child who cannot swallow properly because of this condition. It is an endoscopic technique (no cuts on the skin) with very high success rates and a good safety profile, as long as it is performed in expert hands and with adequate follow-up.
Quick index
What is achalasia and what is POEM?
Achalasia is a problem of the esophagus (the "tube" that carries food to the stomach). The valve at the end, called the lower esophageal sphincter, does not relax properly and, on top of that, the esophagus loses its strength to push. The result: food gets "stuck", and there is choking, regurgitation and, in children, sometimes weight loss or growth problems.
POEM (peroral endoscopic myotomy) involves carefully cutting the muscle fibers of that valve from the inside, using an endoscope that goes in through the mouth. It leaves no scars on the abdomen and allows quick recoveries. Achalasia is rare in children, so most data come from multicenter series and meta-analyses.
Is POEM effective for childhood achalasia? What the studies say
A reassuring message
Overall, the evidence shows that POEM is highly effective in children, with a clinical success of around 90–95% and a clear improvement in symptoms.
Pediatric meta-analyses describe a technical success close to 97% and a clinical success of 88–94% (measured with the Eckardt score ≤3, which assesses symptoms). 1234 In addition, the symptom score drops by an average of about 6.7 points and the pressure of the esophageal valve falls by around 19–21 mmHg. 12
Series from several hospitals confirm this with very concrete numbers:
- • A multicenter series of 117 children showed a clinical success of 90.6% and a drop in the Eckardt score from 7.5 to 0.9.5
- • A nationwide study described a fall in the integrated relaxation pressure from 26.8 to 10.8 mmHg, with a major improvement in symptoms.6
- • Hospital cohorts of 33–37 children report symptom normalization in 85–100%, with follow-up of up to 2–3 years.78
If you want to understand the technique in detail, here is a dedicated page about POEM in achalasia, within my advanced endoscopy area.
Table: success and complications of POEM in children
| Outcome | Approximate range |
|---|---|
| POEM clinical success | 88–95% |
| Success at ≥4–5 years | 95–96% |
| Major adverse events | ~4–13% |
| Reflux / erosions after POEM | ~12–26% (clinical/endoscopic) |
Long-term results and quality of life
One of the most reasonable concerns for families is: "OK, it works now… but will it still work years from now?". The answer from the evidence is encouraging. Follow-ups of 4–5 years or more show a sustained success of around 95%, with no need to repeat treatment in most cases, and high family satisfaction. 91210
And very important for the child's daily life: quality of life after POEM is similar to that of the general population, and comparable to other options such as pneumatic (balloon) dilation or laparoscopic Heller myotomy. 13
Is it safe? Complications and comparison with other techniques
No technique is risk-free, but the safety profile of POEM in children is good. The most common complications are air in the abdomen (pneumoperitoneum), air in the chest (pneumothorax) or small mucosal tears; the vast majority are managed conservatively, without the need to operate again. 81456
The key thing to watch: reflux
The main effect to monitor after POEM is gastroesophageal reflux: symptoms appear in around 12–22% and signs of esophagitis on endoscopy in up to ~26% in some series. That is why prolonged clinical and endoscopic follow-up is recommended; it is usually well controlled with treatment. 121011
And compared with classic surgery? Comparative studies suggest that POEM offers results at least equivalent to and often better than laparoscopic Heller myotomy, with shorter operating times and a similar hospital stay. 131516 In addition, there is an ongoing international clinical trial that will directly compare POEM with balloon dilation in children, which will give even more certainty. 17
My experience with POEM in children
What the studies say is one thing; having a real volume of cases is another, because with a technique like this the team's experience makes the difference. In my case, I regularly perform POEM in the pediatric population within the public health system, at Hospital Universitario La Paz, one of the best pediatric hospitals in Spain, which children with achalasia reach from all over the country. That volume and concentration of cases allow a level of specialization that is hard to match.
And in the private setting, at Hospital San Rafael in Madrid, I perform POEM almost every week. That frequency of procedures translates into something very concrete: we achieve excellent results, fully comparable to those described in the current scientific literature you have seen in this article.
If your child has achalasia or a suspicion of it, we can assess the case and explain the options calmly.
Related reading (to see the "full map")
A personal touch (yes, this is medicine too)
Behind every POEM there is a child and a worried family. My commitment is to perform the technique with the utmost care and to explain every step to you, so that fear turns into confidence.
FAQ: quick questions about POEM in children
Is POEM effective in children with achalasia?
Yes. Clinical success is around 88–95% and the improvement in symptoms is marked. The benefit lasts beyond 4–5 years in most. 1
Is it safe in the pediatric population?
In general yes. Most complications resolve without reoperation and major adverse events are uncommon. 8
What is the main risk to watch for?
Gastroesophageal reflux. That is why clinical and endoscopic follow-up is recommended; it is usually well controlled with treatment. 2
Is it better than Heller surgery in children?
Studies suggest results at least equivalent to and often better than surgery, with shorter times. Trials are ongoing to confirm this. 15
References (clickable)
- Nabi Z, Talukdar R, Chavan R, et al. Outcomes of Per-Oral Endoscopic Myotomy in Children: A Systematic Review and Meta-analysis. Dysphagia (2022). doi:10.1007/s00455-022-10409-5
- Zhong C, Tan S, Huang S, et al. Clinical outcomes of peroral endoscopic myotomy for achalasia in children. Diseases of the Esophagus (2020). doi:10.1093/dote/doaa112
- Lee Y, Brar K, Doumouras A, Hong D. POEM for the treatment of pediatric achalasia: a systematic review and meta-analysis. Surgical Endoscopy (2019). doi:10.1007/s00464-019-06701-5
- Pu X, Huang S, Zhong C, et al. Safety and efficacy of POEM for achalasia in pediatric and geriatric patients: A meta-analysis. World J Gastrointest Endosc (2024). doi:10.4253/wjge.v16.i10.566
- Choné A, Familiari P, Von Rahden B, et al. Multicenter Evaluation of Clinical Efficacy and Safety of POEM in Children. J Pediatr Gastroenterol Nutr (2019). doi:10.1097/mpg.0000000000002432
- Luvsandagva B, Adyasuren B, Bagachoimbol B, et al. Efficacy and safety of POEM for pediatric achalasia: A nationwide study. Medicine (2024). doi:10.1097/md.0000000000038970
- Petrosyan M, Kovler M, Rafie J, et al. Pediatric Achalasia and POEM: Ten-Year Outcomes for 101 Children at a Single Institution. J Pediatr Surg (2025). doi:10.1016/j.jpedsurg.2025.162697
- Petrosyan M, Mostammand S, Shah A, et al. POEM for pediatric achalasia: Institutional experience and outcomes. J Pediatr Surg (2022). doi:10.1016/j.jpedsurg.2022.02.017
- Nabi Z, Ramchandani M, Basha J, et al. POEM Is a Durable Treatment in Children and Adolescents With Achalasia Cardia. Frontiers in Pediatrics (2022). doi:10.3389/fped.2022.812201
- Shimamura Y, Sato H, Yagi R, et al. Clinical Characteristics and Long-Term Efficacy of POEM in Pediatric Achalasia. J Gastroenterol Hepatol (2025). doi:10.1111/jgh.16945
- (Reflux and adverse events — see also refs. 1, 2 and 4.) doi:10.4253/wjge.v16.i10.566
- Peng D, Tan Y, Li C, et al. POEM for Pediatric Achalasia: 21 Cases With a Minimum Follow-Up of 5 Years. Frontiers in Pediatrics (2022). doi:10.3389/fped.2022.845103
- Kuipers T, Mussies C, Lei A, et al. POEM in pediatric achalasia: institutional experience and quality of life. Orphanet J Rare Dis (2025). doi:10.1186/s13023-025-03565-y
- Bozkına A, Erdoğan Ç, Taşçı E, et al. POEM in pediatric achalasia — A two-center retrospective cohort study. Rev Esp Enferm Dig (2025). doi:10.17235/reed.2025.11650/2025
- Dimopoulou A, Dimopoulou D, Analitis A, et al. Laparoscopic Heller myotomy versus POEM in children with achalasia: a systematic review and meta-analysis. Ann Gastroenterol (2024). doi:10.20524/aog.2024.0923
- Sobral J, Machado M, Barbosa J, Barbosa J. Achalasia: laparoscopic Heller myotomy with fundoplication versus POEM — a systematic review and meta-analysis. Esophagus (2024). doi:10.1007/s10388-024-01063-x
- Mussies C, Van Lennep M, Van Der Lee J, et al. Protocol for an international RCT: POEM vs endoscopic balloon dilation for achalasia in children. PLOS ONE (2023). doi:10.1371/journal.pone.0286880
Does your child have achalasia? Let's talk about the options
I'll explain calmly whether POEM is the best alternative in their case and what to expect before, during and after.
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