Mumbai doctors perform complex POEM on 14-month-old

When a young child struggles with persistent vomiting and difficulty swallowing,parents and doctors alike seek answers and effective treatment options. Such symptoms frequently enough indicate serious underlying conditions that require specialized care.this was teh case for a 14-month-old infant from nashik district, whose rare disorder made eating nearly impossible. After a challenging diagnostic journey, the child underwent a groundbreaking procedure at Gleneagles Hospital in Parel, Mumbai, leading to a remarkable recovery. Understanding the complexities of this condition and the innovative treatment used can provide valuable insights for families and medical professionals facing similar challenges.

Understanding Achalasia Cardia in Infants: A Rare but Serious Condition

Achalasia Cardia is an uncommon disorder characterized by the failure of the lower esophageal sphincter-the valve between the esophagus and stomach-to relax properly. this malfunction causes food to become trapped in the esophagus,resulting in symptoms such as persistent vomiting,difficulty swallowing,and malnutrition. In infants,this condition is exceptionally rare,affecting approximately one in 500,000 children,making diagnosis particularly challenging. The case of Neeraj Balu Kavar, a 14-month-old from Chinchore village, highlights how early signs can be subtle and easily mistaken for common feeding issues.

Diagnostic Challenges and clinical Presentation

Neeraj initially appeared healthy and fed normally on milk during his first months. However, problems emerged around nine months when solid foods like khichdi were introduced. What began as feeding difficulties escalated into daily vomiting, rapid weight loss, and recurrent respiratory infections, including three bouts of pneumonia. despite multiple consultations at various clinics, the root cause remained elusive until the family sought specialized care in Mumbai. Extensive endoscopic evaluation revealed a severely dilated esophagus and a completely closed valve at the stomach junction, confirming the diagnosis of Achalasia Cardia.

Innovative Treatment: The Role of per Oral Endoscopic Myotomy (POEM)

Traditional treatments such as balloon dilation or open surgery posed significant risks for Neeraj due to his fragile condition, severe malnutrition, and electrolyte imbalances. Balloon dilation,while less invasive,has a high recurrence rate of about 40% and lacks appropriately sized equipment for infants of Neeraj’s weight (5.9 kg). Open surgery, on the other hand, is invasive and leaves visible scars. To overcome these challenges, the medical team at Gleneagles Hospital employed a novel approach-Per Oral Endoscopic Myotomy (POEM). This minimally invasive technique involves creating an internal incision within the esophageal muscle layers to relieve the obstruction without external cuts.

Due to the child’s small size, the team adapted a bronchoscope, typically used for lung procedures, as adult endoscopes were too large. This made Neeraj the youngest and possibly the smallest patient worldwide to undergo POEM, with only one similar case reported in an 11-month-old infant in China. The procedure, performed on December 9 and lasting 3.5 hours, marked a significant milestone in pediatric gastroenterology in India.

Recovery and Advantages of POEM Over Conventional Methods

Unlike adults who are usually discharged within 24 hours post-POEM, Neeraj was closely monitored for a week to prevent re-feeding syndrome, a possibly fatal complication from rapid nutritional rehabilitation. Gradually, he began eating without vomiting and is steadily gaining weight and strength. POEM offers several benefits compared to traditional treatments: it is scarless, less traumatic, and boasts a success rate of nearly 95%, significantly higher then balloon dilation, where symptoms can recur in up to 60% of cases.Additionally, POEM reduces hospital stays and accelerates recovery, making it especially suitable for vulnerable pediatric patients.

In India, the cost of POEM typically ranges between ₹2.1 lakh and ₹3.8 lakh, reflecting its advanced technology and specialized expertise. Early diagnosis and intervention remain critical, as delayed treatment can lead to severe growth failure and repeated infections. As Dr. Vibhor Borkar, Director of Paediatric gastroenterology and Hepatology, emphasizes, awareness of this rare condition is essential to improve outcomes.

Critically important Facts: Key Points to Remember

• Achalasia Cardia affects approximately 1 in 500,000 infants worldwide.
• Symptoms include persistent vomiting, difficulty swallowing, malnutrition, and recurrent pneumonia.
• Neeraj Balu Kavar was the youngest and smallest child in India to undergo POEM, weighing just 5.9 kg.
• POEM is a minimally invasive endoscopic procedure that avoids external incisions and scars.
• balloon dilation has a 40% recurrence rate and is frequently enough unsuitable for very small infants.
• POEM success rates reach nearly 95%, with significantly fewer symptom recurrences.
• The procedure duration for Neeraj was 3.5 hours, performed using a bronchoscope adapted for pediatric use.
• Post-POEM, careful monitoring is essential to prevent re-feeding syndrome, especially in malnourished children.
• Typical POEM costs in India range from ₹2.1 lakh to ₹3.8 lakh.
• Early diagnosis is crucial to prevent failure to thrive and repeated respiratory infections.

Frequently Asked Questions

Q: What is Achalasia Cardia and how does it affect infants? Achalasia cardia is a rare disorder where the valve between the esophagus and stomach fails to open, causing swallowing difficulties, vomiting, and malnutrition in infants.

Q: Why is POEM preferred over balloon dilation or surgery for infants? POEM is minimally invasive, has a higher success rate (around 95%), avoids external scars, and is safer for fragile infants compared to balloon dilation or open surgery.

Q: How rare is it for infants to undergo POEM? Infants undergoing POEM are extremely rare; Neeraj’s case is among the youngest globally, with only one similar case reported in China.

Q: What are the risks associated with POEM in young children? While POEM is generally safe, risks include complications like re-feeding syndrome post-procedure, which requires careful monitoring during recovery.

Q: How soon can a child eat normally after POEM? Most patients can resume eating within two days, but in malnourished infants like Neeraj, a gradual reintroduction of food over several days is necessary to ensure safety.