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American Oncology Institute @ Nangia Specialty Hospital performs POEM for Achalasia Cardia

A case of achalasia cardia was treated using latest treatment modality known POEM (Peroral Endoscopic Myotomy) at American Oncology Institute @Nangia specialty Hospital, Nagpur.

The patient-Ramesh (name changed, a 45-year-old came to American Oncology Institute at Nangia Specialty Hospital, Nagpur with complaints of difficulty in eating solid and liquid food since 2 years. He had lost about 5kg of weight over 2 yrs and had a history of nasal regurgitation at night. He consulted with Dr Manoj Vyawahare, Consultant Medical Gastroenterologist. On examination the patient had minimal retrosternal pain.

Dr Manoj recommended investigations including Upper GI Endoscopy, which revealed dilated esophagus with significant food residue and significant resistance while crossing the GE junction. Barium swallow revealed dilated esophagus with bird beak appearance at GE Junction suggestive of Achalasia Cardia. Also, esophageal manometry confirmed diagnosis as Type II achalasia cardia. To decide on the further treatment plan, the patient was advised about the treatment options including Heller’s myotomy and peroral endoscopic myotomy [POEM].

POEM is one of the alternative treatment for achalasia cardia. Due to concept of natural orifice transluminal endoscopic surgery (NOTES), it has become popular and widely accepted. With the endoluminal technique, submucosal tunnel was created followed by endoscopic myotomy. POEM is not only indicated in classical achalasia but also other abnormal esophageal motility disorders. Moreover, failures of endoscopic treatment or surgical attempted cases are not contraindicated for POEM. The second attempted POEM is also safe and technically feasible.

The patient underwent POEM [Anterior myotomy]. He recovered completely and his Eckardt score was ‘0’ post procedure, suggestive of significant improvement in dysphagia, pain and nasal regurgitation. The patient is now on follow-up and disease free.

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Dr Manoj Vyawahare, Consultant Medical Gastroenterologist, American Oncology Institute at Nangia Specialty Hospital, Nagpur said, “The method of treatment for Achalasia Cardia include the use of high-resolution manometry to predict the outcome of patients with the introduction of peroral endoscopic myotomy (POEM). Over the last few decades, technology-driven procedures such as POEM (peroral endoscopic myotomy) has become the popular mode of treatment and treatment have significantly improved the results.

With advanced treatment processes and standards, AOI at Nangia Specialty Hospital strives hard to provide better quality outcomes through a multi-disciplinary care program backed by latest technology, and international standard treatment protocols”.

About the Facility
American Oncology Institute at Nangia specialty hospital has a state-of-the art facility that has 100 beds capacity spread in an area of 1,18,000 sq ft. The hospital also has 3 well-equipped modern Operation Theatres and a 21-beds Critical Care Unit. The facility also has a day care and in-patient chemo therapy faclity. AOI uses state-of-the-art technologies such as Trubeam backed by the most modern diagnostic equipment such as PET CT, MRI, GAMMA camera and digital mammograms to ensure that our diagnosis and treatment are precise and effective. The hospital has a centralized TPS for Radiotherapy which is being reviewed on clinical protocols set by UPMC at Pittsburg.

The Hospital also provides services in select allied specialties such as Surgical and Medical Gastro-enterology, Urology, ENT and head & Neck Surgery, Gynecology and critical care. The institute primarily focus on a set of surgical and clinical specialties that requires high end specialty care that may also contribute to the oncology practice. The hospital has plans to start a hematology and Bone Marrow transplant program within a year and shall also focus on combating the growing incidence of blood cancer and related disorders in the Vidarbha Region in the future.

About American Oncology Institute
American Oncology Institute brings to its network of super specialty cancer hospitals in India and South Asia standardized cancer treatment protocols and pathways as followed in the leading Oncology centers in the US. American Oncology Institute operates Comprehensive care centers in Hyderabad, Hyderabad South, Jammu, Guntur, Vijayawada, Ludhiana, Jalandhar, Hisar, Nagpur, Bhubaneswar and Sri Lanka is planning to open four more centers in the current year. American Oncology Institute plans to open 18-20 centers over a period of 3 years across multiple cities in India and South Asia including countries such as Nepal, Myanmar and Bangladesh to provide International standards of cancer care across India and South Asia.

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