Rohit Shishodia

Doctors at a Delhi hospital gave a new lease of life to a 6-year-old by removing an obstruction from her food pipe using Per Oral Endoscopic Myotomy (POEM), an endoscopic surgery used to treat swallowing disorders.

Doctors at the Department of Gastroenterology at Sir Ganga Ram Hospital said that they have recently received a six-year-old girl who was not able to swallow food for almost three years.

She had repeated vomiting and regurgitation of food from mouth and nose which resulted in her marked weight loss, they added.

Elaborating on the case, Prof. (Dr) Anil Arora, Chairman and Head of the Department of Gastroenterology at Sir Ganga Ram Hospital said, “When she came to us she was very thin, emaciated and marasmic (protein malnutrition) and weighed  8-10 Kgs lower than the normal weight of her corresponding peers. We diagnosed her to be suffering from Achalasia Cardia (swallowing disorder) after evaluating her with endoscopy, barium swallow followed by high-resolution oesophagal manometry.”

 “Till recently the established treatment of Achalasia Cardia in children was surgical intervention but in her case, we decided to perform a relatively new endoscopic procedure in this child called POEM (Per Oral Endoscopic Myotomy),” he added.

 “The challenge for us was to do this novel procedure in such a low weight child of this young age of six years (one of the youngest in India to the best of our knowledge) and also the low weight of the child 11 Kg (lowest weight to the best of our knowledge in India) as there was a substantial risk of infection, aspiration and respiratory problem in this emaciated underweight child. There were also going to be limitations of the use of adult endoscopic equipment and accessories used in POEM procedure to be used in a small child,” Prof. Arora pointed out.

Dr Shivam Khare, Consultant, Department of Gastroenterology, Sir Ganga Ram Hospital said, “The POEM procedure consists of four steps namely mucosal entry followed by the creation of submucosal tunnel, initiation and Extension of Myotomy and finally closure of mucosal entry”.

“The above four steps mean cutting the internal lining of the food pipe, creating a tunnel between the muscle layers and the inside lining of the food pipe, then, cutting the tight muscle at the stomach and food pipe junction, and lastly closing the internal lining with Hemoclips after exiting the tunnel,” he explained.

Achalasia cardia is seen rarely in the paediatric population as less than 5% of all cases present below 15 years of age globally.

The doctors said that the procedure took one and half hours and the child’s obstruction and blockage at the junction of the food pipe and stomach were immediately relieved.

After the surgery the child was able to consume a normal diet within four days and was subsequently discharged, they added.

POEM (Per Oral Endoscopic Myotomy) is an endoscopic surgical procedure used to treat obstruction at the lower end of the food pipe when the lower oesophageal sphincter fails to relax (musculature opening) due to a motility disorder called Achalasia Cardia. POEM is a relatively new advanced endoscopic procedure which can be performed in the endoscopic suite itself without any incision on the chest or abdomen, with a minimal post-procedure stay.

“We believe that with increasing expertise and availability of multispecialty team this procedure can be safely done for long-lasting relief from difficulty in swallowing and vomiting of food so that these hapless children can be properly treated and achieve the full potential of physical and mental growth, especially in the formative years of early childhood and adolescence,” Dr Khare said.