Gleneagles Hospital, Mumbai, has achieved a historic medical milestone by successfully performing India’s youngest Per Oral Endoscopic Myotomy (POEM) on a 14-month-old infant. This rare and complex procedure gave a new lease of life to a severely underweight child suffering from Achalasia Cardia, an extremely uncommon condition in infants.
Understanding Achalasia Cardia in Infants
Achalasia Cardia is a rare disorder that affects approximately one in five lakh infants. In this condition, the valve between the food pipe and the stomach fails to open properly, preventing food from passing into the stomach. As a result, children experience repeated vomiting, poor nutrition, frequent respiratory infections, and delayed growth. The exact cause of the disease remains unknown, and diagnosis is often delayed due to its rarity.
A Child’s Struggle with a Rare Condition
The patient, Neeraj Balu Kavar, from Chinchore village in Nashik district, initially appeared healthy and fed well during his early months. However, after nine months of age, his parents noticed persistent vomiting whenever solid foods such as khichdi were introduced. What seemed like a feeding issue soon escalated into a serious health concern.
Over the next three months, Neeraj’s condition worsened steadily. He lost significant weight, became extremely weak, and suffered from repeated chest infections, including three episodes of pneumonia. Consequently, his growth was severely affected, leaving the family distressed and searching for answers.
Journey to Diagnosis and Hope
Despite multiple consultations at local clinics, doctors could not identify the cause of Neeraj’s illness. As his health continued to deteriorate, the family was referred to Dr Vibhor Borkar and travelled from Nashik to Mumbai in search of specialised care.
Upon arrival at Gleneagles Hospital, Parel, in early December, doctors conducted detailed investigations, including a CT scan and endoscopy. These tests revealed that Neeraj’s food pipe was massively dilated, while the valve at its lower end was tightly shut. This confirmed the diagnosis of Achalasia Cardia, finally providing clarity and a path toward treatment.
Choosing POEM: A Minimally Invasive Lifesaving Option
Given Neeraj’s extremely low weight of just 5.9 kg and fragile condition, conventional treatment options such as balloon dilation or open surgery were not suitable. Therefore, the multidisciplinary team decided to perform POEM, a minimally invasive endoscopic procedure carried out entirely from inside the food pipe, without external cuts or scars.
As per the hospital press release, this made Neeraj the youngest and smallest child in India to undergo the POEM procedure, marking a major breakthrough in paediatric gastroenterology.
Expert Insights on a Rare and Complex Case
Dr Vibhor Borkar, Director – Paediatric Gastroenterology and Hepatology, explained that Neeraj’s symptoms were initially mistaken for reflux disease or heart-related issues, which is common in infants. However, detailed evaluation revealed that the underlying problem lay in the food pipe. He emphasised that in Achalasia Cardia, food accumulates in the oesophagus, leading to vomiting and aspiration pneumonia, which severely affects growth and development.
Dr Shankar Zanwar, Senior Consultant Gastroenterologist, described POEM as a procedure that involves carefully cutting the tight muscle at the junction of the food pipe and stomach from within. He noted that while POEM is well-established in adults, performing it in such a small infant required significant innovation. Balloon dilation, he added, has a recurrence rate of nearly 40 percent and is not feasible in infants of such low weight.
A World-Level Achievement in Paediatric Care
Dr Zanwar further highlighted that adult endoscopes are unsuitable for infants. Therefore, the team adapted a bronchoscope typically used for lung procedures to perform the myotomy safely. This case is not only the youngest in India but also among the youngest reported globally. The minimally invasive approach ensured faster recovery and avoided the risks associated with open surgery.
Careful Recovery and Positive Outcome
Due to severe malnutrition, dehydration, and electrolyte imbalance, Neeraj required intensive post-procedure care. Doctors initially kept him nil by mouth and provided nutrition through tube feeding to support healing. Gradually, he began feeding normally.
Today, Neeraj can swallow comfortably without regurgitation. He is better hydrated, nutritionally stable, and showing signs of healthy recovery. Doctors stress that early diagnosis and timely intervention are crucial, as untreated cases can lead to failure to thrive and life-threatening complications.
Anaesthesia Challenges in Infant Endoscopy
Dr Rajan Daftari, Consultant Anaesthesiologist and Chief of the Endoscopy Department, stated that the case was extremely demanding from an anaesthesia perspective. In such small infants, even minor airway compression can be dangerous, and drug dosages must be calculated with absolute precision.
A Family’s Gratitude and Renewed Hope
Neeraj’s mother, Pramila Kavar, expressed heartfelt gratitude, saying that watching her child eat properly and regain strength feels nothing short of a miracle. After months of uncertainty and fear, the family finally has hope for a healthy future.
Commitment to Advanced, Patient-Centric Care
Concluding the milestone, Dr Bipin Chevale, CEO of Gleneagles Hospital Mumbai, reaffirmed the hospital’s commitment to pushing medical boundaries through advanced infrastructure and a strong multidisciplinary approach. He stated that this successful procedure reflects the hospital’s dedication to delivering world-class, minimally invasive treatments and restoring hope for families facing rare and complex medical challenges.