CHENNAI: A bite of samosa or a sip from a cup of tea may be nothing unusual for us. But for 48-year-old Ponni from Kanchipuram, it is an extraordinary feat. Until a few months ago, eating solid food and sipping a liquid item would result in a heartburn and cough, and she would end up vomiting the food and liquid.
For 38 long years, Ponni was suffering from a condition called oesophageal achalasia, where the food pipe (oesophagus) is unable to contract and relax, meaning the food that she ate could not travel down into her stomach as the lower oesophageal sphincter (LSE) won’t open.
“Diagnosing Ponni’s condition was a bit of an ordeal. All these years, she had been prescribed antibiotics for her sore throat. She was starving herself unable to eat, and when she did, the weight of the food she consumed created pressure, and forced itself into her stomach,” said Dr R Ravi, head and senior consultant of the department of gastroenterology and therapeutic endoscopy at Global Hospital, Perumbakkam.
After conducting a barium swallow test, doctors found out that Ponni’s oesophagus had swollen to the size of her stomach.
“Traditional Heller myotomy surgery would involve laparoscopic incision, cutting through the diaphragm fibres. So, we opted for the increasingly popular Peroral Endoscopic Myotomy (POEM) technique, which doesn’t involve surgical incision,” said Dr V Jayanthi, consultant and research officer of the department of gastrointestinal and hepato-pancreato-biliary surgery.
Doctors used an endoscope to move through her oesophagus, and at about 15 cm height from the LSE, a small incision was made in the mucosa (sub-mucosal dissection), between the oesophageal muscle and the inner membrane. “It was a tunnel endoscopy and we cut through the skin along the oesophagus and into the stomach by cutting through the valve. This relaxed her oesophagus. So, whenever she consumes food now, it will pass through the food pipe just like in a normal person,” Dr Ravi added.
The surgery was conducted on May 5 and Ponni was kept under observation. “With POEM, there is no threat of reflux as in Heller myotomy, where because of the incisions there is a probability that food will enter the blood stream or lungs,” Jayanthi said. “I am now eating without pain or fear of vomiting. For a long time, I couldn’t eat more than two idlis, now I am able to eat five to six,” said Ponni.
