Russia’s first POEM in the treatment of achalasia in children

The article describes various methods of treatment of achalasia, for example, endoscopic balloon pneumatic dilation that extends the lower esophageal sphincter, injection of botulinum toxin that decreases cardia tone, minimally invasive endoscopic methods in combination with medicinal therapy, and surgical treatment of patients at the fourth stage of the disease that promotes good or satisfactory clinical results in 98.2% of patients. The present study also introduces an optimal algorithm for the examination of patients with suspected achalasiocardia. X-ray diagnostics and endoscopic examination were used to verify the diagnosis. All these methods ensure timely and correct diagnosis, determining also the stage of the disease development. Stage-wise diagnostics in Russia are mostly based on the classification suggested by B.V. Petrovsky in 1962. This classification is founded upon X-ray examination of the esophagus due to its simplicity and availability. The article also presents a completely novel approach for the treatment of achalasiocardia in Russia, that is, peroral endoscopic myotomy (POEM).This method of endoscopic operation has been used in our clinic since 2014 for adult patients, and in 2016, it has been for the first time in Russia performed on a child. A clinical example of achalasiocardia in a child is presented as well as diagnostic methods, medicinal treatment, and the use of balloon pneumatic dilation resulting in a recurrence that subsequently demanded peroral endoscopic myotomy. This minimally invasive endoscopic operation nowadays is highly effective and prospective for the treatment of achalasiocardia in both adults and children.