Mumbai hospital performs India’s youngest POEM procedure on 14-month-old underweight boy with rare disorder

According to the medical team, the child appeared healthy initially and was able to consume milk normally. However, after nine months of age, he began vomiting repeatedly when solid food was given. Over the next few months, his condition worsened, leading to weight loss and three episodes of pneumonia. After multiple consultations without a clear diagnosis, he was referred to Gleneagles Hospital, Parel, for further evaluation.

Investigations, including endoscopy and imaging, revealed a markedly dilated oesophagus and a tightly closed lower oesophageal valve, confirming Achalasia Cardia. Given the child’s low weight and fragile condition, conventional treatments such as balloon dilation or open surgery were considered high-risk. Doctors opted for POEM, a procedure in which the tight muscle is cut endoscopically to allow food to pass into the stomach.

Dr Vibhor Borkar, Director of Paediatric Gastroenterology and Hepatology at the hospital, said early symptoms of Achalasia Cardia are often mistaken for reflux or cardiac problems in infants, leading to delayed diagnosis. “In this condition, food accumulates in the food pipe and can enter the lungs, causing repeated pneumonia and poor growth,” he said.

Senior gastroenterologist Dr Shankar Zanwar said the procedure required modifications due to the child’s size. “Standard adult endoscopes cannot be used in such young patients, so alternative instruments were adapted to perform the myotomy safely,” he said.

The child was kept under close observation after the procedure and initially supported with tube feeding due to severe malnutrition. Doctors said he has since started feeding orally and is showing signs of nutritional improvement.