Sonia Moreno Madrid
Madrid
Updated Monday, February 26, 2024-15:14
An innovative endoscopic procedure has corrected the disorder that prevented Jordi, 14, from eating solid foods, seriously compromising his development.
Thanks to the collaboration of the
Puerta de Hierro and La Paz hospitals
, both in Madrid, Jordi has seen his dream of enjoying his grandmother's paellas come true.
"They are my heroes
," says Jordi of the doctors and health team who have returned him to normal, without undergoing surgery and with a recovery of just three days.
This morning in the assembly hall of the Puerta de Hierro Majadahonda University Hospital, before doctors and professionals, hospital managers, the Minister of Health of Madrid, and the media, he explains naturally and with a poise that is unusual for his 14 years of age. how the illness that he had suffered since he was 12 made him go through very difficult times, due to his inability to eat normally.
She suffered from
achalasia type II
, a rare disorder that affects the muscle tissue of the esophagus and causes alterations in the motility necessary for food to pass through the digestive tract;
Over time, people who suffer from it can barely swallow.
"At first, I had to eat with two liters of water to be able to swallow," Jordi remembers.
"He needed about two hours to eat, and, of course, he hardly ate anything, he was increasingly thinner and had no energy at all."
The difficulty progressed until in the months before the intervention, the boy was only nourished with shakes.
He was about 15 kilos below his weight and height
, and suffered distressing episodes of choking.
Achalasia type II is a disease of unknown cause in which a degeneration of the ganglion cells in the wall of the esophagus produces alterations in swallowing, explains Enriqueta Román, head of Pediatric Gastroenterology at the Puerta de Hierro Hospital.
"It is a very rare disease, and even less so in pediatric age:
only 4% of these patients debut before 15 years of age
. "
The gastroenterologist points out that studies estimate two cases per million inhabitants worldwide diagnosed in pediatric age.
When the case of Jordi, who lives in the Community of Valencia, came to her attention, the specialist told this medium that "we thought that the best thing we could offer him was an endoscopic treatment that is done in adults with this disease. However , we were faced with the challenge that it has hardly been carried out in children in the world. As we know from international experience in this and other rare diseases in pediatrics, the ideal thing was for it to be carried out by specialists with the most experience in adults, with the support of Pediatric Surgery".
And that is how, after analyzing the case together and
several previous preparatory meetings
, in November of last year, the professionals of the Digestive System Service of Puerta de Hierro with the collaboration of pediatric surgeons from the La Paz University Hospital carried out the endoscopic procedure that culminated, without incident, in the successful correction of Jordi's disease.
Alberto Herreros de Tejada, Section Head of the Endoscopy Unit at the Puerta de Hierro Majadahonda Hospital, is the expert in the technique normally used in adults and whose team has put it into practice in a novel way in this pediatric case.
As he explains, the procedure is known by its acronym,
POEM
(Per-Oral Endoscopic Myotomy).
It consists of making an extensive cut of the muscular layer of the esophagus, after creating a tunnel in the intermediate layer of the esophageal wall using the endoscope.
"As it is a novel intervention in children, we had the support of the pediatric surgeons of La Paz to discuss the suitability of the case; in addition, we counted on them during the intervention and the following days, in case any eventuality or serious complication arose that required surgical intervention," he explains.
Likewise, a box from the Anesthesia ICU
was adapted
to care for children.
The procedure is performed exclusively by endoscopy under general anesthesia.
By not requiring any surgery, it allows the patient to recover to their normal life in a couple of days.
Everything went as expected in Jordi's case:
the technique was performed cleanly in 30 minutes
and three days after the intervention, he was discharged and was already tolerating a crushed diet at that time.
Later, once at his home, he continued to progress and, currently, eats all types of foods, solid and liquid, with complete normality.
Now he can enjoy the paellas that his grandmother prepares for him and, of course, the occasional hamburger.
Puerta de Hierro Hospital has extensive experience in POEM in adults, a technique described 15 years ago in Japan.
Since 2019, they have treated more than 65 cases with it, and their technical success rate is close to 100%, which, by the way, has supported them to apply as a reference center in this technique.
Regarding its application in children, Alberto Herreros de Tejada details, "we knew from the few series of patients published around the world that among the main peculiarities was the logical adaptation of the technique to the length of the esophagus of a child who also It has a weaker mucosa. Also, and this motivated us to continue, the clinical success of the technique was comparable to that obtained in adults:
above 96% at five years; some studies even suggested that it could be higher in the children".
Like all advanced endoscopic and interventional treatments, there were concerns about possible complications, and this is where having the support of pediatric surgeons and anesthesiologists has been essential.
Javier Serradilla, pediatric surgeon from La Paz, specifies that "our work here has been to provide support and security to the patient; to be present in case a possible complication made our intervention necessary."
The surgeon indicates that one of the main concerns is that a perforation would occur: "The muscle layer in a child is more fragile than that of an adult, that is why we had a blocked operating room with everything prepared to be able to solve it through traditional surgery." .
Another key element in the success of the intervention has been the
anesthetic management
, in which eight anesthesiologists have participated.
Javier García, head of Anesthesiology at Puerta de Hierro, highlights that these pediatric cases "are apparently harmless procedures, but at any time they can lead to serious complications, such as pneumothorax or acute hemorrhage, so it is necessary to establish appropriate plans." "contingency", including the preparation of a pediatric ICU.
For the specialist, the success of this case lies in the fact that a very complex technique has been carried out "where it is best done, but with a device that guarantees safety in the event of any
eventual vital complication
."
The contribution of Antesiology has also been key in the control of postoperative pain, since it is an intervention that in the acute phase, the first day, hurts a lot, "similar to what happens with an esophageal dilation";
Therefore, they had a specific analgesic procedure.
This deployment of professionals must include the important work of Nursing.
The collaboration of all of them is what has allowed, in the words of counselor Fátima Matute, this success of "precision and personalized medicine; innovation and alliance, which in this case extends not only between services, but between centers, because
hospitals do not operate, professionals operate"
.
For all these professionals Jordi had words of gratitude in the presentation this morning in the Puerta de Hierro assembly hall, and also in a congratulatory video that he sent last Christmas to the team, where he named those who have treated him since the moment of his diagnosis, and which ended with an image so normal and so loaded with meaning of Jordi eating a huge hamburger.