Peroral endoscopic myotomy after gastric bypass: An effective solution for de novo achalasia

Luo, Ran B.; Montalvo, Domingo; Horgan, Santiago

doi:10.1016/j.soard.2016.10.004

Cited by 9 publications

(3 citation statements)

References 15 publications

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“…The eight articles included the reported outcomes of 40 patients treated with POEM for achalasia after bariatric surgery (34 RYGB, 6 LSG) [15,17,18,[20][21][22][23]. In the case reported by Donatelli et al, POEM was performed in a female patient with prior multiple bariatric surgical procedures: a laparoscopic lap band, followed by LSG and, finally, by RYGB [22].…”

Section: Resultsmentioning

confidence: 99%

Peroral Endoscopic Myotomy for Achalasia after Bariatric Surgery: A Case Report and Review of the Literature

Maselli,

Fiacca,

Pellegatta

et al. 2023

Diagnostics

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Introduction: Achalasia following bariatric surgery is a rare phenomenon with diverse potential physiopathological origins. Aims: This article aims to explore the hypothetical physiopathological connection between bariatric surgery and the subsequent onset of achalasia. Material and Methods: A review was conducted to identify studies reporting cases of peroral endoscopic myotomy (POEM) after bariatric procedures and detailing the outcomes in terms of the technical and clinical success. Additionally, a case of a successful POEM performed on a patient two years after undergoing laparoscopic sleeve gastrectomy (LSG) is presented. Results: The selection criteria yielded eight studies encompassing 40 patients treated with POEM for achalasia after bariatric surgery: 34 after Roux-en-Y gastric bypass (RYGB) and 6 after LSG. The studies reported an overall technical success rate of 97.5%, with clinical success achieved in 85% of cases. Adverse events were minimal, with only one case of esophageal leak treated endoscopically. However, a postprocedural symptomatic evaluation was notably lacking in most of the included studies. Conclusions: Achalasia poses a considerable challenge within the bariatric surgery population. POEM has emerged as a technically viable and safe intervention for this patient demographic, providing an effective treatment option where surgical alternatives for achalasia are limited. Our findings highlight the promising outcomes of POEM in these patients, but the existing data remain limited. Hence, prospective studies are needed to elucidate the optimal pre-surgical assessment and timing of endoscopic procedures for optimizing outcomes.

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Section: Resultsmentioning

confidence: 99%

Peroral Endoscopic Myotomy for Achalasia after Bariatric Surgery: A Case Report and Review of the Literature

Maselli,

Fiacca,

Pellegatta

et al. 2023

Diagnostics

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“…For the rare morbidly obese achalasia patient, Roux-en-Y gastric bypass in conjunction with POEM could also be an effective, but rather invasive, antireflux treatment option. 11,12…”

Section: Discussionmentioning

confidence: 99%

Electrical Stimulation of the Lower Esophageal Sphincter to Treat Gastroesophageal Reflux After POEM

et al. 2018

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As per-oral endoscopic myotomy (POEM) is not followed by any anti-reflux procedure, a common concern is the risk of postoperative gastro-esophageal reflux disease (GERD). Electrical stimulation of the lower esophageal sphincter (LES-EST) could be an option for post-POEM GERD. A 68-year old male obese patient underwent successful POEM but developed GERD not responsive to proton pump inhibitors. Consecutively, the patient had implanted an electrical LES stimulation device, consisting of bipolar LES-electrodes connected to a subcutaneous pulse generator. POEM reduced the Eckardt score (9 vs. 0), the LES resting pressure (52.0 vs. 16.4 mmHg), and the Integrated Relaxation Pressure (62.0 vs. 10.0 mmHg). LES-EST substantially reduced post-POEM GERD symptoms. GERD-HRQL scores indicated the elimination of heartburn (26 vs. 7) and regurgitation (24 vs. 3) at three months. A reduced total number refluxes (82 vs. 14) was observed. The %-time of pH below 4 was only slightly reduced (8.6% to 6.2%).LES-EST appears to be a feasible option to symptomatically treat post-POEM GERD for patients not ideal for conventional anti-reflux surgery.

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“…All patients were treated successfully, with no complications, and significant symptom improvement. Luo et al [60] also reported a case of a 67-year-old female with previous RYGB that developed achalasia and was successfully treated with POEM. Bashir et al [54] described 6 patients with achalasia and surgical history of RYGB who underwent POEM; all but one patient had improvement of symptoms.…”

Section: Achalasia In Bariatricsmentioning

confidence: 98%

Bariatric endoscopy: current primary therapies and endoscopic management of complications and other related conditions

Castro¹,

Guerron²

2020

Mini-invasive Surg

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The steady increase in bariatric surgery has led to room for innovation. Endoscopy has become an important tool for evaluation, diagnosis, management of complications, and even for primary bariatric interventions. Leaks are the most feared complication and new endoscopic therapies have been developed such as septotomy, doublepigtail stents, and endoscopic vacuum therapy. Additionally, primary bariatric endoscopic procedures are gaining popularity and the new procedures include intragastric balloons, stoma reduction, aspiration therapy, among others. The altered anatomy and reoperation increase the risk of complications after bariatric surgery, especially when managing conditions like achalasia, gastroparesis, and cholelithiasis. Per-oral endoscopic myotomy, per-oral pyloromyotomy, and endoscopic ultrasound-guided transgastric endoscopic retrograde cholangiopancreatography provide a less invasive approach to address these conditions. This narrative review article intends to expose current endoscopic therapies for the management of primary bariatric procedures, complications and related conditions.

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Peroral endoscopic myotomy after gastric bypass: An effective solution for de novo achalasia

Cited by 9 publications

References 15 publications

Peroral Endoscopic Myotomy for Achalasia after Bariatric Surgery: A Case Report and Review of the Literature

Peroral Endoscopic Myotomy for Achalasia after Bariatric Surgery: A Case Report and Review of the Literature

Electrical Stimulation of the Lower Esophageal Sphincter to Treat Gastroesophageal Reflux After POEM

Bariatric endoscopy: current primary therapies and endoscopic management of complications and other related conditions

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