NEW DELHI: A six-year-old underweight child, who was not able to swallow food for almost three years due to obstruction at the junction of the food pipe and stomach, received a new lease of life after undergoing a novel endoscopic procedure at a leading private facility in Delhi, authorities said on Friday. Doctors at the Sir Ganga Ram Hospital claimed that the girl was the "youngest patient in India" to undergo this procedure -- POEM (per oral endoscopic myotomy).
POEM is an endoscopic procedure used to treat obstruction at the lower end of the food pipe due to failure of relaxation of lower esophageal sphincter (musculature opening) due to motility disorder called achalasia cardia, they said.
It is a relatively new advanced endoscopic procedure which can be performed in the endoscopic suite itself without any incision on chest or abdomen, with a minimal post-procedure stay, the hospital said in a statement,
Recently, the department of gastroenterology of the hospital received the young patient who was "not able to swallow food, for almost three years," it said.
She had repeated bouts of vomiting and regurgitation of food from the mouth and nose which had resulted in her marked weight loss, doctors said.
Dr Anil Arora, chairman and head of the department of gastroenterology, said, "When she came to us, she was very thin, emaciated and marasmic (protein malnutrition) and weighed 8-10 kg 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 esophageal manometry".
Till recently the established treatment of achalasia cardia in children was surgical intervention, but in her case, it was decided to perform a relatively new endoscopic procedure, called POEM, he said.
According to Dr Shivam Khare, consultant at the hospital's department of gastroenterology, "The POEM procedure consists of four steps: Mucosal entry; creation of submucosal tunnel; initiation and extension of myotomy; and 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, doctors said.
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 statement said.
Arora said the challenge for the team was to do this "novel procedure" in such a "low weight child, aged six years (one of the youngest in India to the best of our knowledge) and also low weight 11 kg (lowest weight to the best of our knowledge in India), as there was substantial risk of infection, aspiration and respiratory problem in this emaciated underweight child".
There was also going to be limitations of the use of adult endoscopic equipment and accessories used in POEM procedure on a small child, he said.
The procedure took 1.5 hours and the child's obstruction and blockage at the junction of the food pipe and stomach was immediately relieved, the statement said.
This would not have been possible without the ardent team support of a well-trained team of endoscopic assistants, pediatrics anaesthetist and pediatrics surgeons. After the surgery the child was able to consume a normal diet within four days and left the hospital smilingly, it said.
"With state-of-the-art advanced diagnostic procedures, like high-resolution esophageal manometry and high-definition endoscopes, disorders like achalasia cardia can be easily diagnosed.
"We have already successfully performed this procedure in 427 cases till date in our hospital. But this procedure in a young child of six years, weighing only 11 kg, has been performed for the first time in India," Arora claimed.
