The girl was unable to swallow food for three years; doctors treated her with a special endoscopic procedure

Delhi: Recently, a 6-yearsold girl reached the Gastroenterology Department of Sir Ganga Ram Hospital in Delhi for treatment, as she was unable to swallow food for almost 3 years. She had frequent vomiting problems and immediately after eating food, he used to vomit from his mouth and nose. This was causing a lot of trouble to the girl and her weight was also decreasing continuously. The girl was 6 years old and her weight was only 11 kg. When the doctors examined, it was found that she had a disease called Achalasia Cardia, in which food is not swallowed. Through specific endoscopic she was treated.

Professor Dr. Anil Arora, chairman of the Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, Delhi, told that when the girl came to him for treatment, she was very thin and weak. Her weight was 8-10 kg less than the normal weight of her age. Endoscopy followed by high resolution esophagealmanometry was performed, which revealed that the girl was suffering from Achalasia Cardia (food swallowing disorder). Treatment of Achalasia Cardia in such young people is surgical, but in comparison the doctors decide to perform an endoscopic procedure in this child (POEM)-Per Oralendoscopic Myotomy. With the help of POEM, the closed feeding tube of the girl was opened.

Dr. Arora said that the biggest challenge was to perform endoscopic procedure on this youngest and underweight girl of 6 years and 11 kg. Such a weak and underweight girl was at the highest risk of infection and respiratory problems. Using the adult endoscopic and assistive equipment used in the POEM procedure in a young child was a complex task.

According to Dr. Shivam Khare, Consultant, Department of Gastroenterology, Sir Ganga Ram Hospital, there are four levels in this process. First cutting inner lining of the food pipe, creating a path between the muscle layers and the inner lining of the food pipe, then cutting the complex muscle at the junction of the stomach and food pipe, and finally closing the inner layer with hemoclips. Younger children are less likely to develop Achalasia Cardia, and less than 5% of Achalasia Cardia patients are under the age of 15. This ‘Special Endoscopic Procedure (POEM)’ took one and a half hours to perform and the patient got immediate relief from the blockage at the junction of esophagus and stomach after the procedure.

Per oral endoscopic myotomy is an endoscopic procedure used to treat Achalasia Cardia, a blockage in the lower part of the food pipe. POEM is a newer endoscopic procedure in which it performed through an endoscope without any incisions on the chest or abdomen. In this, the patient needs to be admitted to the hospital for one to two days. Dr. Arora said that with the help of state-of-the-art advanced diagnostic procedures and high-definition endoscopes, diseases like Cholangia Cardia can be easily treated. So far this procedure has been done successfully in 427 patients in the hospital, but for the first time in India, this procedure has been done successfully in a 6-year-old child weighing 11 kg at Sir Ganga Ram Hospital.