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Patient Profile
Patient Name
Mr. Rohan Pawar
Consultant
Dr. Vipulroy Dayanand Rathod
Diagnosis
Type II Achalasia Cardia with Severe Swallowing Difficulty
Age / Gender
39 Years / Male
Hospital
Fortis Hospitals Limited, Mulund, Mumbai
Past History
Progressive dysphagia (3 years) · Two prior balloon dilatations with temporary relief · Significant weight loss
Patient Background
Mr. Rohan Pawar, a 39-year-old IT professional from Thane, Maharashtra, had struggled with worsening difficulty swallowing for over three years. Both solids and liquids would stick in his chest, often regurgitating undigested food hours after eating. Two previous balloon dilatations at other centres gave only short-lived relief before his symptoms returned. With surgical myotomy (Heller’s myotomy) being suggested next, his family searched for the Best Gastroenterologist In Mumbai offering an incision-free alternative. Dr. Vipulroy Rathod, Director of Gastroenterology at Fortis Mulund and South Asia’s pioneer of Endoscopic Ultrasound with over 20,000 EUS procedures, recommended Per-Oral Endoscopic Myotomy (POEM), an advanced third-space endoscopy technique that relieves achalasia entirely through the mouth, with no external cuts.
Symptoms
Progressive dysphagia — difficulty swallowing both solids and liquids, worsening over three years
Regurgitation — bringing up undigested food, often hours after eating, especially when lying down
Chest pain and pressure — a tight, gripping sensation behind the breastbone during
Significant weight loss — 11 kg over a year due to inability to eat properly
Nighttime cough and choking — from regurgitated food, disturbing sleep and risking aspiration
Diagnostic Method
High-definition upper endoscopy
a dilated oesophagus with retained food and a tight, non-relaxing lower oesophageal sphincter, ruling out an obstructing tumour
High-resolution oesophageal manometry
the gold standard, confirming Type II achalasia with absent peristalsis and failed sphincter relaxation
Timed barium swallow
showed marked hold-up of contrast at the gastro-oesophageal junction with the classic 'bird-beak' narrowing
Endoscopic Ultrasound (EUS)
excluded a pseudo-achalasia from any tumour or external compression at the junction
Pre-procedure evaluation
fitness for advanced therapeutic endoscopy assessed and confirmed
Disease Diagnosed
Mr. Pawar was diagnosed with Type II achalasia cardia — a disorder in which the muscle at the lower end of the oesophagus fails to relax, blocking food from passing into the stomach, while the oesophageal body loses its normal squeezing motion. Repeated balloon dilatation had provided only temporary relief. As a gastroenterology specialist for complex swallowing disorders, Dr. Rathod identified Per-Oral Endoscopic Myotomy (POEM) as the most durable, incision-free solution to permanently release the tight sphincter.
Risks if Left Untreated:
Progressive oesophageal dilatation leading to an end-stage, non-functioning oesophagus
Severe malnutrition and continued weight loss
Aspiration pneumonia from regurgitated food entering the lungs
Long-standing achalasia carries a small increased risk of oesophageal cancer over time
Treatment Plan
Dr. Vipulroy Rathod performed Per-Oral Endoscopic Myotomy (POEM), a third-space endoscopy procedure that cuts the tight oesophageal muscle from the inside, entirely through the endoscope, restoring normal swallowing without any incision on the chest or abdomen.
Why POEM Was Chosen Over Surgery
01 — No Surgical Incision
The entire myotomy is performed through the mouth using the endoscope. No chest or abdominal cuts, no external scars, and no surgical wound.
02 — Durable, Definitive Relief
Unlike balloon dilatation, which often needs repeating, POEM delivers a long-lasting myotomy that addresses the root cause of the obstruction.
03 — Tailored Muscle
Cut The length of the myotomy can be precisely customised to the patient's achalasia subtype, improving outcomes over a one-size-fits-all approach.
04 — Faster Recovery
Days of recovery instead of weeks. Most patients resume a normal diet within days, compared to a longer recovery after laparoscopic or open surgery.
How the Procedure Was Performed
- Mucosal entry — a small incision was made in the inner lining (mucosa) of the oesophagus to create an entry point, several centimetres above the tight sphincter.
- Submucosal tunnel — a working tunnel was carefully created in the ‘third space’ between the mucosa and the muscle layer, advancing down toward and across the gastro-oesophageal junction.
- Selective myotomy — the inner circular muscle fibres of the lower oesophagus and sphincter were precisely divided under direct vision, releasing the obstruction.
- Junction crossing confirmed — the myotomy was extended a defined distance onto the stomach side to ensure complete relief of the tight segment.
- Tunnel closure — the mucosal entry point was sealed with endoscopic clips, leaving no external wound and allowing the lining to heal naturally.
Procedure Summary
| Procedure | Per-Oral Endoscopic Myotomy (POEM) — third-space endoscopy |
| Approach | Entirely transoral; no external incision |
| Duration | 75 minutes |
| Sedation | General anaesthesia with anaesthesia support |
| Hospital Stay | Two nights; contrast study before starting oral feeds |
Doctor’s Quote
“For years, the only definitive option for achalasia was surgery to cut the muscle from the outside. POEM changes that completely. Working through the mouth, we create a tunnel inside the oesophageal wall and release the tight muscle from within, with no incision at all. Mr. Pawar swallowed comfortably the day after his procedure and was eating normally within days. For achalasia, this is the difference between an operation and a scar-free recovery.”
Dr. Vipulroy Rathod, FASGE | Gastroenterologist in Mumbai | Director, Gastroenterology and Hepatobiliary Sciences, Fortis Hospital Mulund
Post-Procedure Guidelines
Clear liquids after a contrast study confirms healing, advancing to soft and then normal diet over one to two weeks
Acid suppression (proton pump inhibitor) to manage any post-POEM reflux, a known trade-off of the procedure
Eat slowly, chew well, and avoid lying down immediately after meals during early recovery
Watch for and promptly report fever, chest pain, or difficulty breathing
Follow-up with Dr. Vipulroy Rathod for symptom review and monitoring for reflux
Outcome
| Timepoint | Result |
|---|---|
| Day 1 | Contrast study confirmed free flow into the stomach; comfortable swallowing of liquids |
| Day 2 | Discharged on a soft diet with no wound care required |
| 1 Week | Swallowing solids comfortably, regurgitation resolved, sleeping through the night |
| 1 Month | Eating a full normal diet, weight beginning to recover, chest pain gone |
| 3 Months | Sustained relief; manometry and symptom scores markedly improved |
| 6 Months | Weight fully restored, eating normally, mild reflux well controlled on medication |
Long-Term Expectations
With the tight oesophageal muscle durably released, Mr. Pawar’s swallowing has normalised and his quality of life has been restored. Achalasia has no cure for the underlying nerve loss, so periodic follow-up will monitor for any return of symptoms and for post-POEM reflux, which is managed effectively with acid-suppressing medication. Long-term surveillance and prompt evaluation of any new swallowing difficulty will remain part of his ongoing care.
Patient Feedback
“For three years, every meal was a struggle and I had lost so much weight. Two earlier treatments helped only for a few months. Dr. Rathod did a procedure through my mouth with no cuts, and the very next day I could swallow water without it sticking. Today I eat normally again and have my life back. I am truly grateful.”
Rohan Pawar, 39 | Thane, Maharashtra“Watching my husband unable to eat was heartbreaking. Dr. Rathod explained the POEM procedure clearly and reassured us throughout. The result has been remarkable — he is healthy, eating well, and back to his normal self. We cannot thank him enough.”
Mrs. Sneha Pawar, Patient’s Wife | Thane, Maharashtra
