Pace Hospitals | Best Hospitals in Hyderabad, Telangana, India

Blog Post

Endoscopic Excellence: POEM Surgery Relieving Severe Swallowing Difficulties in a 68 Y.O. Patient

Pace Hospitals

The Gastroenterology team at PACE Hospitals successfully performed a Peroral Endoscopic Myotomy (POEM) on a 68-year-old female patient suffering from severe difficulty swallowing liquids and solids for the past four months. Diagnosed with achalasia cardia type II through oesophageal manometry, the minimally invasive procedure effectively alleviated oesophageal obstruction, enhanced food passage, and restored normal swallowing function.


Chief complaints

An adult female patient presented to PACE Hospitals, Hitech City, Hyderabad with chief complaints that she had been experiencing difficulty in swallowing food and liquids for 4 months. These symptoms had significantly impacted her daily life, leading her to seek medical attention.

Medical History

The patient had no significant past medical history of gastrointestinal conditions, except for the recent onset of dysphagia. The patient’s history also indicated a progressive decrease in the ability to swallow food and liquids, causing significant distress and nutritional challenges.


The patient previously underwent a POEM procedure for achalasia cardia type II at some other hospital. However, despite the surgery, she continued to experience persistent or recurrent symptoms, indicating the possibility of an incomplete myotomy, post-procedure complications, or underlying motility disorders. The ongoing swallowing difficulties had a significant impact on her daily life, prompting her to seek further medical evaluation for appropriate management.

On Examination

Upon examination, the patient appeared stable and showed no signs of acute distress. She was conscious, cooperative, and well-oriented. Her vital signs were within normal limits, with a temperature of 98.3°F, blood pressure of 120/80 mmHg, pulse rate of 88 beats per minute, and SpO₂ of 99% on room air. A systemic examination revealed a soft, non-tender abdomen, with no signs of discomfort or palpable abnormalities.

Diagnosis

Diagnostic evaluations using upper gastrointestinal endoscopy (UGI) and oesophageal manometry confirmed achalasia cardia type II, a motility disorder marked by impaired relaxation of the lower oesophageal sphincter.


Prior to the POEM procedure, a chest X-ray (AP view) was performed to assess lung and heart health and rule out any pre-existing respiratory conditions.

Medical Decision Making (MDM)

Based on the clinical findings and investigation reports, the decision was made by the interventional gastroenterologist, transplant hepatologist, pancreatologist, and endocrinologist, Dr. Govind Verma, along with Dr. M Sudhir, to proceed with a Peroral Endoscopic Myotomy (POEM) to treat achalasia cardia, a minimally invasive procedure that helps alleviate symptoms by cutting the muscle fibers of the lower oesophageal sphincter.


In preparation for the planned procedure, the patient discontinued antiplatelet therapy for 10 days. This precautionary measure aimed to minimize the risk of bleeding complications during and after the intervention. The duration of antiplatelet cessation varies depending on the specific medication and the nature of the procedure.

Treatment

The patient underwent Peroral Endoscopic Myotomy (POEM), a minimally invasive endoscopic procedure. This technique involved creating a submucosal tunnel within the oesophageal wall to access the lower oesophageal sphincter. A precise myotomy was then performed on the circular muscle fibers, effectively alleviating the obstruction caused by the hypertonic sphincter. The procedure was successfully completed without intraoperative complications, ensuring optimal conditions for postoperative recovery.

Post-Treatment

The postoperative recovery was smooth, with no signs of infection or complications. The patient was initiated on IV fluids to maintain hydration and administered antibiotics to prevent potential infections. Supportive management, including pain relief, was provided to ensure comfort and promote recovery. Throughout the hospital stay, she remained hemodynamically stable, with no adverse symptoms such as fever, vomiting, or abdominal pain. Following a stable recovery, the patient was discharged in good condition.

Discharge medications

Upon discharge, the patient was prescribed antibiotics, proton pump inhibitors (PPIs), antiplatelets, and expectorants.

Discharge advice

She was advised to follow a clear liquid diet for the first five days, followed by a semisolid diet for the next ten days, before gradually transitioning to a soft diet.

Emergency Care

The patient was informed to contact the Emergency Ward of PACE Hospitals, Hyderabad if she observed any symptoms such as fever, abdominal pain, or vomiting.

Review notes

The patient was also advised to follow up with Dr. Govind Verma in the outpatient department after 7 days to review her condition.

Managing Bleeding Risks: Antiplatelet Cessation Before POEM

Antiplatelet medications are discontinued before a POEM procedure to reduce the risk of excessive bleeding during and after surgery. Since POEM involves creating a submucosal tunnel and cutting muscle fibers within the oesophageal wall, the procedure carries an increased bleeding risk, which antiplatelet agents can worsen by inhibiting clot formation. These medications are typically stopped several days before the procedure, depending on their half-life and the patient's overall risk factors. However, discontinuation must be carefully weighed against the risk of thrombotic events, requiring an individualized evaluation by the medical team. For instance, guidelines recommend stopping P2Y₁₂ receptor antagonists like clopidogrel approximately 5 to 7 days before high-risk endoscopic procedures to minimize bleeding complications. The decision to withhold antiplatelet therapy must be carefully assessed in consultation with the prescribing physician to ensure patient safety.

Request an appointment

Fill in the appointment form or call us instantly to book a confirmed appointment with our super specialist at 04048486868

Appointment request - health articles

Gallbladder Stones causes & treatment Podcast with Dr. Suresh Kumar S from PACE Hospitals, Hyderabad
By Pace Hospitals April 3, 2025
Listen to Dr. Suresh Kumar S in the Gallbladder Stones Podcast from PACE Hospitals, discussing symptoms, causes, types, complications, treatment & Preventive measures for gallstones.
Sports Medicine Doctor Near Me | Best Sports Medicine Doctor in Hyderabad | Sports Injury Specialist
By Pace Hospitals April 3, 2025
Consult the best sports medicine doctor in Hyderabad, India at PACE Hospitals. Our top sports injury specialists provide advanced treatment for athletes and active individuals.
Dr. Raghuram from PACE Hospitals explaining Shoulder Pain causes, symptoms & Treatment in this video
By Pace Hospitals April 3, 2025
Watch Dr. Raghuram from PACE Hospitals discuss the causes of shoulder pain, its diagnosis, and effective treatment and prevention strategies in this informative video.
Best knee replacement surgeon in Hyderabad | knee replacement doctor near me | top 10 knee doctor
By Pace Hospitals April 2, 2025
At PACE Hospitals, the best knee replacement surgeons in Hyderabad, India, provide advanced robotic-assisted and minimally invasive knee joint replacement surgeries for faster recovery and long-term success.
Chronic pancreatitis Symptoms & Causes | Chronic pancreatitis Treatment in India
By Pace Hospitals April 2, 2025
Chronic pancreatitis is a long-term inflammation of the pancreas that leads to pain, digestion issues, and complications like diabetes. Learn about its types, symptoms, causes, risk factors, , Complications, Diagnosis, treatment & prevention.
Irritable Bowel Syndrome (IBS) Awareness Month - April 2025, Theme & Importance
By Pace Hospitals April 2, 2025
Irritable Bowel Syndrome (IBS) Awareness Month is a globally recognized healthcare event observed every April. This year’s theme, “More Than A Stomachache,” sheds light on the hidden struggles of IBS. Beyond digestive issues, it affects mental health, confidence, and daily life.
Dr. Suresh Kumar S from PACE Hospitals explains symptoms & treatment in this video.
By Pace Hospitals April 2, 2025
Suffering from gallbladder stones? Watch Dr. Suresh Kumar S from PACE Hospitals explains the causes, symptoms, and best treatment options to relieve discomfort. Watch now for expert insights.
Case study of a woman who underwent treatment for hernia & recti separation at PACE Hospitals
By Pace Hospitals April 1, 2025
Explore this case study of a 67-year-old woman at PACE Hospitals, who underwent treatment for hernia and recti separation using eTEP-RS surgery, performed by our expert Surgical Gastroenterology team, ensuring a smooth recovery & significant relief from her symptoms.
Success Story, a 70 Y.O. patient with aortic stenosis treated with TAVI procedure at PACE Hospitals
By Pace Hospitals March 29, 2025
Explore the case study of a 70-year-old patient with severe aortic stenosis at PACE Hospitals, where the expert cardiology team successfully performed a repeat TAVI procedure, relieving aortic stenosis symptoms.
Show More

Share by: