Manipal Hospital Vijayawada Successfully Managed the Swallowing Disorder in an 86-Year-Old

In a remarkable medical achievement, an 86-year-old man presented to Manipal Hospital Vijayawada with a long-standing history of difficulty in swallowing, recent onset regurgitation, and nocturnal cough. Despite his symptoms, he showed no loss of appetite but had significant emaciation. Regurgitation is the involuntary return of swallowed food or liquid back into the mouth.

The patient was evaluated for possible esophageal cancer. Tests showed a dilated esophagus with food stuck but no signs of cancer. A Contrast-Enhanced Computed Tomography (CECT) of the chest and upper abdomen ruled out any tumors pressing on the esophagus. Further investigation through high-resolution esophageal manometry confirmed that he has Type I Achalasia Cardia, a condition impacting the ability to swallow.

Achalasia Cardia is a rare condition where nerve damage makes it hard for the lower esophagus to relax and for food to move down, symptoms include difficulty in swallowing, regurgitation, chest pain, and weight loss, significantly affecting the quality of life.

There are three main treatment options for Achalasia Cardia: pneumatic dilation, laparoscopic Heller’s myotomy, and peroral endoscopic myotomy (POEM). After considering the risks and benefits of each option, it was decided to proceed with the advanced POEM procedure due to the patient's age and high surgical risk.

The POEM procedure, performed by Dr. Battina Rajesh and Dr. Rajesh Chandra, both Consultants in Medical Gastroenterology at Manipal Hospital, included four main steps:

· Making a mucosal incision about 10 cm above the gastroesophageal junction.

· Creating a submucosal tunnel that extends toward the stomach.

· Cutting the esophageal muscle to relax the gastroesophageal junction.

· Closing the mucosal incision with endoclips.

The procedure took about an hour and was completed without any complications. After the surgery, the patient was kept nil by mouth for a day, then gradually transitioned to clear fluids and a soft diet. He experienced no fever, chest pain, or other issues.

The patient improved quickly and was able to eat a normal diet without difficulty or regurgitation. His weight began to recover, and a follow-up endoscopy showed no food residue or resistance at the gastroesophageal junction.

Dr. Battina Rajesh, Consultant Medical Gastroenterology, stated, “POEM is a safe and effective treatment for Achalasia Cardia, especially for high-risk surgical patients. This case highlights POEM's effectiveness across all age groups, including the elderly.” Dr. Rajesh Chandra, Consultant in Medical Gastroenterology, added, “The success of this procedure emphasizes our advanced capabilities at Manipal Hospitals. We strive to achieve the best outcomes for all patients, regardless of age or medical history.”

Dr. Sudhakar Kantipudi, Cluster Director, Manipal Hospital, Vijayawada, “At Manipal Hospital, The successful use of the POEM procedure in this 86-year-old patient not only highlights our specialized capabilities in managing complex conditions like Achalasia Cardia, but also underscores the importance of personalized treatment."

This successful case highlights the advanced expertise and innovative procedures at Manipal Hospital, Vijayawada offering hope to patients with complex esophageal disorders.