Tamil Nadu’s First-of-its-Kind Endoscopic Procedure

In a first-of-its-kind procedure in Tamil Nadu, Rela Hospital successfully performed an advanced endoscopic procedure, Peroral Endoscopic Myotomy (POEM), in an eight-year-old boy diagnosed with Type II achalasia cardia, an extremely rare condition. The disorder affects the nerves controlling the muscles of the food pipe (oesophagus), making it difficult for food and liquids to pass into the stomach. The young patient had been experiencing progressively worsening difficulty in swallowing both solid food and liquids. Following the procedure, he made a satisfactory recovery and was able to resume clear liquids, followed by a soft diet, within 24 hours. Under normal circumstances, during swallowing, the lower oesophageal sphincter, a muscular valve at the lower end of the food pipe, relaxes to allow food and liquids to pass into the stomach. In achalasia cardia, however, this muscle fails to relax adequately and remains abnormally tight, obstructing the passage of food into the stomach. This results in progressive difficulty in swallowing, and can also affect a child's nutrition, growth and overall health. Achalasia is extremely rare in children, affecting only 0.1-0.18 per 100,000 children annually. Traditionally, achalasia is treated through a laparoscopic procedure, in which the surgeon accesses the food pipe through small incisions in the abdomen to release the tight muscle. This surgery needs longer post-operative care (3-4 days) with external sutures with morbidities. POEM, in contrast, is an advanced endoscopic technique. It passes an endoscope through the mouth and creates a small tunnel within the wall of the food pipe to reach and carefully divide the tight muscle fibres. This relieves the obstruction and allows both solids and liquids to pass more easily into the stomach. The entire procedure is performed through the mouth, without any external cuts, stitches or visible scars. The procedure was successfully performed by Dr. SNK Chenduran, Senior Consultant & Endoscopic Surgeon, Department of Medical Gastroenterology, with support from expert anaesthesia team, pediatric team and nursing team. In his comments, Dr. SNK Chenduran said, “Performing POEM in an eight-year-old child requires considerable technical expertise and precision, as the oesophagus in children is much smaller and narrower than in adults, providing very limited working space to perform the procedure. Further creating a tunnel within the wall of the oesophagus requires meticulous dissection in the correct tissue plane for delicate tissues in children. Despite these challenges, we successfully completed the procedure in approximately 50 minutes. This is an important advancement in offering children with this rare condition an effective, minimally invasive treatment option.” Dr. Dinesh Jothimani, Director - Hepatology and Medical Gastroenterology, Rela Hospital, said,”imagine this child with achalasia going through a major surgery, feeding through the tubes, and long hospital stay. Evolution of such innovative endoscopic techniques and expertise, made the child go home within 24 hours and with complete restoration of swallowing. Early recognition and timely treatment particularly important in the management of Achalasia. Parents should watch out for warning signs such as difficulty swallowing food or even water, regurgitating undigested food, repeated vomiting, unexplained weight loss or coughing while eating. These symptoms should not be dismissed as ordinary eating difficulties in children. Any child experiencing persistent difficulty in swallowing should be evaluated by a doctor. Early diagnosis and appropriate treatment can prevent complications such as malnutrition, poor weight gain and food entering the lungs.” Commenting on the milestone, Prof. Mohamed Rela, Chairman & Managing Director, Rela Hospital, said, “While POEM is an established treatment for achalasia in adults, performing it in children calls for a much higher degree of technical precision and specialised expertise. Only a limited number of advanced therapeutic endoscopists and centres have the expertise to perform paediatric POEM. Successfully performing this procedure for the first time in Tamil Nadu marks a significant milestone in the state’s advanced therapeutic endoscopy capabilities. It reflects our commitment to bringing highly specialised, minimally invasive treatment options to children, enabling them to benefit from incisionless procedures, potentially quicker recovery and an earlier return to normal activities.”