First Successful Independent Peroral Endoscopic Myotomy (POEM) for Achalasia Cardia: A Milestone Case Report from Nepal.

Achalasia cardia is an uncommon esophageal motility disorder characterized by failure of relaxation of the lower esophageal sphincter and loss of peristalsis in the lower part of the esophagus. Peroral Endoscopic Myotomy (POEM) has emerged as a minimally invasive intervention equivalent to Heller myotomy and an effective treatment modality. We present the first successful solo POEM procedure performed in Nepal by an interventional gastroenterologist, who has managed a 45-year-old patient with long-standing dysphagia and a history of failed pneumatic dilatation with success. The procedure was uneventful. The patient showed symptomatic improvement postoperatively with minimal reflux. This case highlights the feasibility and safety of independently performed POEM in a resource-limited setting. It shows the diaspora of interventional gastroenterology in Nepal and begins a new era for the same.