At the leading edge of pediatric GI surgery

Achalasia and gastroparesis are disorders that affect peristalsis in the esophagus and stomach, respectively, preventing normal digestion. When medical therapy fails, surgery is usually the next step.

Children with achalasia may find it hard or painful to swallow and feel full after just a few bites. Laparoscopic Heller myotomy is the gold standard for surgical achalasia management, and Children’s National has offered it since its inception. Now they are taking laparoscopy further with per-oral endoscopic myotomy (POEM), which allows myotomy to be performed internally through an endoscope—incision-free.

“Even laparoscopic achalasia surgery involves an overnight stay and some pain,” says Timothy Kane, MD, Division Chief of General and Thoracic Surgery at Children’s National. “A POEM procedure leaves no external scarring and minimal pain afterward.”

With gastroparesis, children may have refractory nausea and vomiting and be able to eat only a few bites at a time. When diet changes and medication are inadequate, surgery may be needed. A new technique uses a pacemaker connected to the stomach to stimulate stomach muscle contraction.

“Pacemaker placement offers a distinct advantage because we can turn it off or remove it if it is no longer necessary,” said Dr. Kane. “Bringing the gastric pacemaker and the POEM procedure to Children’s National, we can offer more advanced techniques for these conditions than any other institution on the East Coast.”

After a physician’s referral, specialists in the Comprehensive Motility Program in the Division of Gastroenterology, Hepatology and Nutrition at Children’s National employ a range of techniques to identify conditions like achalasia and gastroparesis.