KOLKATA: A six-year-old girl, the youngest patient in India, who was not able to swallow food for almost three years, undergoes removal of obstruction in food pipe by a special endoscopic procedure at Sir Ganga Ram Hospital.
Recently the Department of Gastroenterology at Sir Ganga Ram Hospital received a patient who had repeated vomitings and 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, said, “When she came to us, she was very thin, emaciated and marasmic (protein malnutrition). She weighed 10kgs lower than the normal weight of her corresponding peers.”
The doctor 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, the team decided to perform a relatively new endoscopic procedure POEM (Per Oral Endoscopic Myotomy).
Talking about the most challenging part of this entire procedure Dr Arora said, “The challenge for us was to do this novel procedure in such a low-weight child of this young age, one of the youngest in India to the best of our knowledge. It is also a challenge because of the low weight (11kg) of the child, which is the lowest to the best of our knowledge. There were substantial risks of infection, aspiration and respiratory problems 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 to be used in a small child,” the doctor adds.
According to Dr Shivam Khare, Consultant, Department of Gastroenterology, Sir Ganga Ram Hospital, “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,” Dr Khare explained.
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.