POEM Procedure for Six-Year Battle Against Achalasia Ends in Triumph

In a breakthrough procedure, PACE Hospitals’ Gastroenterology team successfully performed a POEM (Peroral endoscopic myotomy) surgery on a 46-year-old male patient with Achalasia, significantly improving swallowing function and quality of life.

Chief complaints

A 46-year-old male patient, presented to PACE Hospitals, Hitech City, Hyderabad with a long-standing history of progressive difficulty swallowing both solids and liquids since 2018. Additionally, he had been suffering from a nocturnal cough for the past two weeks, prompting him to seek expert care.

Medical History

Upon closer examination, it was revealed that the patient had been struggling with difficulty swallowing both solids and liquids for several years, and over time, this problem had worsened. He also experienced frequent regurgitation, which affected his daily life and prompted his admission to PACE Hospitals for further treatment.

Diagnosis

After a detailed clinical evaluation and diagnostic workup, including upper gastrointestinal endoscopy and esophageal manometry, the diagnosis of Achalasia Cardia Type II was confirmed.

Achalasia Cardia is a motility disorder of the esophagus, characterized by the failure of the lower esophageal sphincter to relax properly, leading to difficulty in swallowing. In this particular case, the condition was classified as Type II, as per Eckardt’s score, which rated his symptoms as moderate. This condition severely impacted his ability to consume both liquids and solids, significantly reducing his quality of life.

Treatment Approach

After consultations with team of Gastroenterologists including Dr. Govind Verma, an Interventional Gastroenterologist, Dr. M Sudhir, a Consultant Gastroenterologist, and Dr. Padma Priya, a consultant Gastroenterologist, the treatment plan was finalized to perform a Peroral Endoscopic Myotomy (POEM) procedure. POEM is a minimally invasive endoscopic procedure that provides an alternative to traditional surgery. 

The approach involves making a small incision in the mucosa of the esophagus to cut the underlying muscle layers, effectively relaxing the lower esophageal sphincter and improving the passage of food. This technique is highly effective for patients with Achalasia and offers quicker recovery times compared to conventional surgical methods.

Procedure Overview

Before the surgery, the patient underwent a detailed pre-Anesthesia Checkup (PAC) to assess his fitness for the procedure. This included evaluating his cardiovascular health and ensuring that he was in optimal condition for anesthesia and surgery. After receiving the necessary clearances and appropriate antibiotic prophylaxis, the POEM surgery was successfully performed without any complications.

The POEM procedure was successfully carried out under general anesthesia. Using an endoscope inserted through the mouth, the surgical team performed myotomy on the lower esophageal sphincter, ensuring minimal disruption to surrounding tissues. The procedure was well tolerated, and no immediate complications were noted.

Postoperative Course

Following the procedure, the patient reported mild chest discomfort, which is a known post-procedural symptom. A high-resolution chest CT was performed, revealing minimal pneumothorax, basal atelectasis, and small bilateral pleural effusions. In response, he was started on high-flow oxygen therapy for two days, alongside intravenous fluids, antibiotics, proton pump inhibitors (PPIs), and antifungal medications as part of the recovery protocol.

On the second day of post-surgery, an oral gastrografin study was conducted. The results indicated transient contrast retention in the lower esophagus, with no signs of leakage, confirming the success of the procedure. The patient was gradually introduced to a liquid diet, which he tolerated without issues.

Condition at Discharge

By the time of his discharge, the patient was in stable condition. His dysphagia had notably improved, and he was able to tolerate liquids comfortably. The patient’s overall hemodynamic stability and symptom relief were reassuring, and he was discharged with clear follow-up instructions.

Dietary Instruction

• Liquid diet for 2 days
• Soft diet for the next 3 days
• Transition to a normal diet, thereafter, as tolerated
  

Urgent Care & Follow-up

Department of Gastroenterology