6-year-old girl becomes youngest to successfully undergo POEM procedure for obstruction in food pipe
Jul 22, 2022
New Delhi [India] July 22 : The Department of Gastroenterology at Sir Ganga Ram Hospital, Delhi, successfully treated a 6-year-old patient who could not swallow food for almost 3 years, as she became the youngest patient to recover after undergoing POEM (Per Oral Endoscopic Myotomy) procedure.
For the past three years, she suffered regurgitation of food from the mouth and nose which resulted in her marked weight loss.
Prof (Dr) Anil Arora, Chairman and Head of the Department of Gastroenterology at Sir Ganga Ram Hospital informed, "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 (Figure 1) followed by high-resolution oesophagal manometry."
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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)."
Prof Arora further added, "The challenge for us was to do this novel procedure in such a low weight child of this young age of 6 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."
According to Dr Shivam Khare, Consultant, Department of Gastroenterology, Sir Ganga Ram Hospital, "The POEM procedure consists of four steps: (A) Mucosal entry (B) Creation of submucosal tunnel (C) Initiation and Extension of Myotomy and (D) 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. Achalasia cardia is seen rarely in the pediatric population as less than 5 per cent of all cases present below 15 years of age globally.
The procedure took one and a half hours and the child's obstruction and blockage at the junction of the food pipe and stomach were immediately relieved.
This would not have been possible without the ardent team support of a well-trained team of Endoscopic Assistants, Pediatrics anaesthetists and Pediatrics Surgeons. After the surgery, the child was able to consume a normal diet within 4 days and left the hospital smiling.
POEM (Per Oral Endoscopic Myotomy) is an endoscopic procedure used to treat obstruction at the lower end of the food pipe due to failure of relaxation of the lower oesophagal sphincter (musculature opening) due to 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.
