Mumbai hospital performs scarless advanced endoscopic procedure on two-yr-old suffering from hirschsprung’s disease

Mumbai: The Gleneagles Hospital at Parel has become the first in Mumbai to successfully perform a rare and scarless procedure called Per-Rectal Endoscopic Myotomy (PREM) on a two-year-old child suffering from a congenital condition that made him unable to pass stool naturally since birth.

Globally, only 13 such procedures have been reported, and this is the first case to be treated by the endoscopic method in Mumbai.

The child, who had been solely dependent on daily enemas for over two years due to hirschsprung’s disease, is now leading a normal life after the procedure.

He is free from abdominal pain and swelling, without any external stitches, and no longer needs further medical intervention.

The family travelled from Nashik to Mumbai in December 2024 and consulted Dr Vibhor Borkar, Paediatric Gastroenterologist, who suspected hirschsprung’s disease.

A few diagnostic tests like barium enema, endoscopy biopsy, and manometry confirmed the condition at the hospital.

Dr Borkar said, “Hirschsprung’s disease occurs when nerve cells (ganglion cells) in the lower part of the large intestine fail to develop, causing stool to accumulate, causing blockage and leading to chronic constipation. Hirschsprung’s disease affects 1 in 5,000 to 10,000 children. There is no medical management for this condition, and it can even become life-threatening due to infections. In very young babies, delayed passage of the first green potty (meconium) can be an early sign."

"Older children usually suffer from swollen stomachs, vomiting, poor weight gain, and constant constipation while some may suffer from infections. Standard treatment requires major surgery that is either open or laparoscopic where the affected part of the intestine is removed and rejoined."

“However, in this child’s case, we used a minimally invasive technique called Per-Rectal Endoscopic Myotomy (PREM), which avoids any external scarring,” he added.

Dr Shankar Zanwar, Interventional Gastroenterologist, said, “The child had a congenital condition called hirschsprung’s disease, where the last part of the intestine lacks the necessary nerve cells, preventing stool from passing. As a result, the portion above it keeps enlarging, like a blocked pipe building pressure. When the child came from Nashik to us in Mumbai, he was extremely uncomfortable, his stomach was swollen, and he couldn’t pass stool without daily enemas.”

"After confirming the diagnosis through manometry and biopsy, the hospital treated the child using an advanced endoscopic technique known as PREM. This procedure is done under general anesthesia where we were helped by Dr Aditya Prabhudesai and Dr Dhanashree Karkhanis. The whole procedure is done endoscopically where a small cut is made just inside the anus of the patient. From this cut a tunnel was made within the layers of the intestine and a nonfunctional segment of the intestine which lacks nerves was cut internally. The entry cut is then closed with clips."

"As the procedure is done endoscopically no scar or cut is seen on the body surface and the patient is pain-free after the procedure. The entire procedure lasted 3 hours. This procedure allowed us to manage the condition without traditional open surgery. Everything was done internally through an endoscope and there were no cuts or stitches outside. Within two days, the child was discharged and no longer needed enemas. His stomach has flattened, and he now passes stool normally. This procedure has truly changed his life," Zanwar added.