Hyderabad — In a medical milestone for Telangana, doctors at Apollo Hospitals Secunderabad have successfully treated patients suffering from Achalasia Cardia using the Peroral Endoscopic Myotomy (POEM) procedure, a cutting-edge, minimally invasive technique that could transform the management of this debilitating esophageal disorder. The development marks one of the first documented cases of POEM being performed in the state, positioning Apollo as a leader in advanced gastrointestinal care in South India.
What Happened
Achalasia Cardia is a rare and chronic esophageal motility disorder characterized by the inability of the lower esophageal sphincter (LES) to relax properly, leading to severe swallowing difficulties, regurgitation, chest pain, and malnutrition. Left untreated, the condition can result in life-threatening complications, including esophageal dilation, aspiration pneumonia, and an increased risk of esophageal cancer.
The POEM procedure, introduced globally in the last decade, offers a revolutionary alternative to traditional surgical treatments. Unlike conventional methods such as laparoscopic Heller myotomy (LHM), which requires external incisions, POEM is performed entirely endoscopically. A specialized endoscope is used to create a submucosal tunnel in the esophageal wall, allowing surgeons to precisely cut the overactive LES muscles without open surgery. The technique is associated with shorter hospital stays, reduced postoperative pain, and faster recovery times.
Apollo Hospitals Secunderabad confirmed that its team of gastroenterologists and surgeons successfully performed the procedure on multiple patients, though the hospital has not yet released specific data on the number of cases or detailed clinical outcomes. The adoption of POEM aligns with a broader global shift toward endoscopic interventions for esophageal disorders, which are increasingly favored over invasive surgeries due to their safety and efficacy.
Why It Matters
Achalasia Cardia remains significantly underdiagnosed in India, often misidentified as gastroesophageal reflux disease (GERD), esophageal cancer, or other gastrointestinal conditions. According to a 2023 study published in the Indian Journal of Gastroenterology, the prevalence of Achalasia in India is estimated at 1 in 100,000 individuals, though experts believe the actual number may be higher due to diagnostic challenges. The successful implementation of POEM at Apollo Hospitals could serve as a catalyst for wider adoption of advanced endoscopic techniques in regional healthcare centers, potentially improving early detection and treatment outcomes.
The procedure’s minimally invasive nature is particularly significant in a country where surgical risks, long recovery times, and financial constraints often deter patients from seeking treatment. POEM eliminates the need for external incisions, reducing the risk of infections and complications while allowing patients to resume normal activities within days rather than weeks. However, the technique’s reliance on specialized equipment and highly trained practitioners may limit its accessibility outside major urban hospitals like Apollo.
Background and Context
Achalasia Cardia has historically been managed through a combination of pharmacological, endoscopic, and surgical interventions. Traditional treatments include:
– Pneumatic dilation: A balloon is used to stretch the LES, providing temporary relief but often requiring repeated procedures.
– Botulinum toxin injections: Temporarily paralyzes the LES muscles, but effects wear off within months.
– Laparoscopic Heller myotomy (LHM): A surgical procedure that cuts the LES muscles but requires external incisions and carries risks of postoperative reflux and scarring.
POEM, first performed in Japan in 2008, has since gained traction in the U.S. and Europe as a safer and more effective alternative. A 2022 meta-analysis published in Gastrointestinal Endoscopy found that POEM had a clinical success rate of over 90% at five years, comparable to LHM but with fewer complications. The procedure’s adoption in India has been gradual, with only a handful of hospitals in metropolitan cities like Mumbai, Delhi, and Bengaluru offering it prior to Apollo’s initiative in Secunderabad.
Competing Claims and Uncertainty
While POEM is widely regarded as a breakthrough in Achalasia treatment, its long-term efficacy and cost-effectiveness remain subjects of debate. Key areas of uncertainty include:
1. Durability of Results: While short-term outcomes are promising, long-term data on POEM’s effectiveness beyond a decade are limited. Some studies suggest a risk of post-procedure reflux, which may require lifelong medication.
2. Cost and Accessibility: POEM is significantly more expensive than traditional treatments, with costs ranging from ₹3-5 lakh (approximately $3,600-$6,000) per procedure in India. While Apollo Hospitals has not disclosed its pricing, the high cost could exclude low-income patients, particularly in a country where out-of-pocket healthcare expenses remain a major burden.
3. Training and Infrastructure: POEM requires advanced endoscopic skills and specialized equipment, which are not widely available in public hospitals or smaller private clinics. The procedure’s success depends heavily on the expertise of the medical team, raising concerns about consistency in outcomes across different healthcare settings.
4. Insurance Coverage: Most health insurance policies in India do not cover POEM, classifying it as an “experimental” or “elective” procedure. This further limits access for patients who cannot afford the upfront costs.
Apollo Hospitals has not yet released peer-reviewed data on its POEM outcomes, making it difficult to independently verify the procedure’s success rate in its Secunderabad facility. The hospital’s announcement, while promising, should be viewed as an early step in a broader evaluation of the technique’s viability in India.
What to Watch Next
1. Expansion of POEM in India: If Apollo’s initial cases demonstrate sustained success, other private hospitals in Hyderabad and beyond may adopt the procedure. Public hospitals, such as those under the Telangana government’s Aarogyasri health scheme, could also explore partnerships with Apollo to make POEM more accessible.
2. Regulatory and Insurance Reforms: Advocacy groups may push for POEM to be included in standard insurance coverage, particularly if long-term data confirm its cost-effectiveness. The Indian Council of Medical Research (ICMR) could also issue guidelines on the procedure’s use, standardizing training and safety protocols.
3. Patient Awareness Campaigns: Given the underdiagnosis of Achalasia in India, Apollo and other hospitals may launch awareness initiatives to educate patients and general practitioners about the condition’s symptoms and treatment options. Early diagnosis is critical, as delayed treatment can lead to irreversible esophageal damage.
4. Comparative Studies: Future research comparing POEM with LHM and pneumatic dilation in the Indian context could provide clearer guidance on the most effective and affordable treatment pathways. Apollo’s data, if published, would be a valuable contribution to this body of evidence.
5. Technological Advancements: Innovations in endoscopic tools, such as robotic-assisted POEM, could further reduce procedure times and improve precision. Apollo’s adoption of POEM may accelerate investment in such technologies in India.
Conclusion
Apollo Hospitals Secunderabad’s successful use of the POEM procedure for Achalasia Cardia represents a significant advancement in India’s gastrointestinal healthcare landscape. The technique offers a minimally invasive, highly effective alternative to traditional surgeries, with the potential to improve quality of life for thousands of patients suffering from this rare and often misdiagnosed disorder. However, challenges related to cost, accessibility, and long-term outcomes must be addressed before POEM can become a standard treatment option across the country.
For now, the development underscores the importance of specialized tertiary care in managing complex medical conditions and highlights the need for greater investment in advanced medical training and infrastructure. As more data emerges from Apollo’s cases, the procedure’s role in India’s healthcare system will become clearer—offering hope for patients who have long struggled with limited treatment options.
Story synopsis gathered from: Telangana Today — source.
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Story synopsis gathered from: Google News India – Top Stories — source.
