Healthier, Happy Lives Blog

Deion Brown of San Jose, Calif. was a typical teenager with a healthy appetite. So he and his mother knew something was wrong last summer when he could no longer gobble everything on his plate.

“Everything would get stuck right in the middle of my throat,’’ Deion said.

Water helped some, but mostly he ended up regurgitating and throwing up food. He began losing weight and feeling tired all the time.

At first doctors thought Deion had allergies, then acid reflux. Finally, a gastroenterologist diagnosed him with esophageal achalasia, a condition in which tight muscle fibers in the lower esophagus prevent food and liquids from passing through the esophagus to the stomach. Deion was referred to James Wall, MD, a pediatric surgeon at Lucile Packard Children’s Hospital Stanford.

Wall had good news. Not only could he help Deion swallow again, the 16-year-old would be one of the first pediatric patients in the U.S. to undergo a highly skilled surgery that would require no incisions and result in very little pain or recovery time. Known as POEM – per-oral endoscopic myotomy, the procedure is conducted through a patient’s mouth. Instead of performing laparoscopic surgery, using small incisions through a patient’s chest or abdomen, Dr. Wall works with flexible tools through the mouth to access and divide the tight muscular fibers of the lower esophagus, allowing for the passage of food and liquids.

When Deion successfully underwent the POEM procedure in April, he became Wall’s second patient receiving this treatment. The first was in February on a 17-year-old girl, in what is believed to be the first POEM procedure at a children’s hospital in North America. Wall has since performed a third, and all had speedy recoveries.

“Deion went home the next day and was eating like a champ in two weeks,” Wall said.

Dr. Wall was assisted in the first pediatric POEM by Homero Rivas, MD, a professor of surgery specializing in digestive and minimally invasive surgeries at Stanford Hospital and Clinics.  Rivas introduced the POEM procedure at Stanford in 2012. The procedure was first introduced in Japan in 2008 and has been used on adults in the United States since 2010.

“There are no scars whatsoever and no chances of infection from incision,’’ Wall said. “As a surgeon, having someone return to see you in follow-up without an incision to check is unusual, but very gratifying.”