Laparoscopic Heller Myotomy and Roux-en-Y Gastric Bypass as Treatment for Patients with Achalasia and Morbid Obesity: Outcomes in a Short Series of Patients

Ithurralde-Argerich, Javier; Rosner, Laura; Faerberg, Alejandro; Puma, Rolando; Ferro, Diego; Cuenca-Abente, Federico

doi:10.1089/lap.2020.0331

Cited by 3 publications

(2 citation statements)

References 29 publications

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“…In gastric surgery for gastric cancer, the main arteries, excluding the short gastric artery, are ligated for lymph node dissection; therefore, fundoplication requiring the ligation of at least several branches of the short gastric artery carries the risk of causing ischemia in the remnant stomach. Limited data are available on the prevalence of RE or symptomatic GERD after achalasia interventions using balloon dilation or LHM in patients after gastric surgery 29 . POEM after RY gastric bypass has been described in small case series 30,31 with reasonably high technical and clinical success rates and acceptable rates of acid reflux.…”

Section: Discussionmentioning

confidence: 99%

“…Limited data are available on the prevalence of RE or symptomatic GERD after achalasia interventions using balloon dilation or LHM in patients after gastric surgery. 29 POEM after RY gastric Adverse events are defined using Clavien-Dindo classification grade II or higher. ‡ Reflux esophagitis on endoscopy (Los Angeles classification, ≥grade A) and symptomatic GERD were analyzed in 3120 and 3132 patients, respectively, who were followed up.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of peroral endoscopic myotomy for esophageal motility disorders after gastric surgery: Japan Achalasia Multicenter Study

Nakamura

Sato

Onimaru

et al. 2022

Digestive Endoscopy

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Objectives: Patients with esophageal motility disorders (EMDs) including achalasia after gastric surgery have not been thoroughly characterized. Furthermore, the efficacy of peroral endoscopic myotomy (POEM) in this population should be clarified. Methods:In this retrospective multicenter study of 3707 patients with EMDs, 31 patients (0.8%) had a history of gastric surgery. Patient characteristics and POEM efficacy were compared between patients with and without previous gastric surgery. Results:In patients with EMD after gastric surgery, age at EMD diagnosis was higher (72.0 years), male sex was predominant (90.3%), and the American Society of Anesthesiologists physical status score was higher (≥II, 48.4%). High-resolution manometry (HRM) findings did not reveal significant differences. In patients who underwent gastric surgery, atrophic gastritis was common (80.6%), and gastric cancer was the primary surgical indication (32.3%). Distal gastrectomy was performed in 28 patients (90.3%). POEM was effective (3.3% adverse events; 100% treatment success). The incidence rates of reflux esophagitis (RE) and symptomatic gastroesophageal reflux disease (GERD) were 60.0% and 16.7%, respectively, without significant intergroup differences, and severe RE was not observed in the long-term followup. Extended gastric myotomy was a risk factor for RE. Conclusion:Patients with gastric surgery often present severe disease manifestations; the surgical indication is mainly gastric cancer. HRM findings can be similarly used for diagnosis in patients with and without gastric surgery. POEM maintains safety and efficacy with acceptable RE and symptomatic GERD rates. To prevent RE, extended myotomy should be avoided.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Efficacy of peroral endoscopic myotomy for esophageal motility disorders after gastric surgery: Japan Achalasia Multicenter Study

Nakamura

Sato

Onimaru

et al. 2022

Digestive Endoscopy

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Surgical approaches for achalasia and obesity: a systematic review and patient-level meta-analysis

Kunz,

Ashraf,

Klonis

et al. 2023

Langenbecks Arch Surg

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Purpose Synchronous and metachronous presentations of achalasia and obesity are increasingly common. There is limited data to guide the combined or staged surgical approaches to these conditions. Methods A systematic review (MEDLINE, Embase, and Web of Science) and patient-level meta-analysis of published cases were performed to examine the most effective surgical approach for patients with synchronous or metachronous presentations of achalasia and obesity. Results Thirty-three studies with 93 patients were reviewed. Eighteen patients underwent concurrent achalasia and bariatric surgery, with the most common (n = 12, 72.2%) being laparoscopic Heller’s myotomy (LHM) and Roux-en-Y gastric bypass (RYGB). This combination achieved 68.9% excess weight loss and 100% remission of achalasia (mean follow-up: 3 years). Seven (6 RYGB, 1 biliopancreatic diversion) patients had bariatric surgery following achalasia surgery. Of these, all 6 RYGBs had satisfactory bariatric outcomes, with complete remission of their achalasia (mean follow-up: 1.8 years). Sixty-eight patients underwent myotomy following bariatric surgery; the majority (n = 55, 80.9%) were following RYGB. In this scenario, per-oral endoscopic myotomy (POEM) achieved higher treatment success than LHM (n = 33 of 35, 94.3% vs. n = 14 of 20, 70.0%, p = 0.021). Moreover, conversion to RYGB following a restrictive bariatric procedure during achalasia surgery was also associated with higher achalasia treatment success. Conclusion In patients with concurrent achalasia and obesity, LHM and RYGB achieved good outcomes for both pathologies. For those with weight gain post-achalasia surgery, RYGB provided satisfactory weight loss, without adversely affecting achalasia symptoms. For those with achalasia after bariatric surgery, POEM and conversion to RYGB produced greater treatment success.

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Obesity and esophageal dysmotility

Shah

Raffa

Naik

2022

Obesity and Esophageal Disorders

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Laparoscopic Heller Myotomy and Roux-en-Y Gastric Bypass as Treatment for Patients with Achalasia and Morbid Obesity: Outcomes in a Short Series of Patients

Cited by 3 publications

References 29 publications

Efficacy of peroral endoscopic myotomy for esophageal motility disorders after gastric surgery: Japan Achalasia Multicenter Study

Efficacy of peroral endoscopic myotomy for esophageal motility disorders after gastric surgery: Japan Achalasia Multicenter Study

Surgical approaches for achalasia and obesity: a systematic review and patient-level meta-analysis

Obesity and esophageal dysmotility

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