NEW DELHI: An advanced liver cirrhosis patient from Himachal Pradesh, who had complex dual obstruction in the food pipe, underwent a successful endoscopic treatment at Sir Gangaram Hospital. The procedure successfully addressed two separate oesophageal conditions in the patient.
The 45-year-old man from Shimla was diagnosed with chronic liver disease (cirrhosis), a condition characterised by progressive liver shrinkage. This led to complications, including the formation of large, winding blood vessels called oesophageal varices at the food pipe-stomach junction, creating a risk of severe oral bleeding.
The patient also faced two additional critical food pipe conditions: achalasia cardia and a substantial lower oesophageal diverticulum. The achalasia cardia prevented normal swallowing due to an overly tight lower oesophageal sphincter. This caused food to become trapped in the chest, leading to frequent vomiting, regurgitation, and pneumonia from food accumulation.
Medical professionals noted this unique case where two oesophageal conditions were treated simultaneously in a patient with advanced cirrhosis and varices through a single endoscopic procedure. Following unsuccessful treatments at various medical centres, the patient recovered within three days and can now eat and swallow normally.
Dr Shivam Khare, Consultant at Sir Ganga Ram Hospital’s Gastroenterology Department, highlighted the treatment challenges. The options included high-risk surgery or endoscopy, complicated by swollen dilated veins at the gastro-oesophageal junction. The medical team collaborated with interventional radiologists Dr Arun Gupta, Dr Ajit Yadav, and Dr Raghav Seth to create a detailed treatment strategy.
Dr Anil Arora described the peroral endoscopic myotomy (POEM) procedure, which involved mucosal entry, submucosal tunnel creation, diverticulum myotomy, and lower oesophageal sphincter myotomy. Special precautions prevented bleeding from varices during treatment.
He emphasised that this successful treatment represented a significant achievement, enabling the patient to resume normal eating habits within a week post-treatment.
