Alberto Aiolfi1, Stefania Tornese2, Gianluca Bonitta2, Emanuele Rausa2, Giancarlo Micheletto3, Davide Bona2. 1. Department of Biomedical Science for Health, Division of General Surgery, Istitituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy. alberto.aiolfi86@gmail.com. 2. Department of Biomedical Science for Health, Division of General Surgery, Istitituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy. 3. Department of Pathophysiology and Transplantation, INCO and Department of General Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy.
Abstract
INTRODUCTION: The development of achalasia after Roux-en-Y gastric bypass (RYGB) is rare. Heller myotomy (HM) is the gold standard treatment while peroral endoscopic myotomy (POEM) is an emerging technique with promising results. The aim of this narrative review was to summarize the current knowledge on the treatment of esophageal achalasia after RYGB. METHODS: PubMed, EMBASE, and Web of Science databases were consulted. All articles that described the management of achalasia after RYGB were included in this narrative review. RESULTS: Twelve studies for a total of 28 patients were included. The age of the patient population ranged from 44 to 70 years old and 80% were females. Overall, 61.5% underwent laparoscopic RYGB while 38.5% underwent open RYBG. The elapsed time from the RYGB to myotomy ranged from 14 months to 14 years. Dysphagia (64%) and regurgitation (60.7%) were the most commonly reported symptoms; type I achalasia was diagnosed in 50% of patients. Surgical HM was performed in 17 patients (61%) while POEM was performed in 11 patients (39%). Postoperative morbidity was 3.6% with no differences comparing surgical HM and POEM (6% vs. 0%, p = 0.43). The follow-up time ranged from 1 to 43 months. The overall recurrence rate requiring reoperation was 7% with no differences comparing surgical HM and POEM (12% vs. 0%; p = 0.25). CONCLUSION: Both HM and POEM seem feasible, safe, and effective in the management of achalasia after RYGB. The role of POEM in the management algorithm of these patients should be further evaluated.
INTRODUCTION: The development of achalasia after Roux-en-Y gastric bypass (RYGB) is rare. Heller myotomy (HM) is the gold standard treatment while peroral endoscopic myotomy (POEM) is an emerging technique with promising results. The aim of this narrative review was to summarize the current knowledge on the treatment of esophageal achalasia after RYGB. METHODS: PubMed, EMBASE, and Web of Science databases were consulted. All articles that described the management of achalasia after RYGB were included in this narrative review. RESULTS: Twelve studies for a total of 28 patients were included. The age of the patient population ranged from 44 to 70 years old and 80% were females. Overall, 61.5% underwent laparoscopic RYGB while 38.5% underwent open RYBG. The elapsed time from the RYGB to myotomy ranged from 14 months to 14 years. Dysphagia (64%) and regurgitation (60.7%) were the most commonly reported symptoms; type I achalasia was diagnosed in 50% of patients. Surgical HM was performed in 17 patients (61%) while POEM was performed in 11 patients (39%). Postoperative morbidity was 3.6% with no differences comparing surgical HM and POEM (6% vs. 0%, p = 0.43). The follow-up time ranged from 1 to 43 months. The overall recurrence rate requiring reoperation was 7% with no differences comparing surgical HM and POEM (12% vs. 0%; p = 0.25). CONCLUSION: Both HM and POEM seem feasible, safe, and effective in the management of achalasia after RYGB. The role of POEM in the management algorithm of these patients should be further evaluated.
Authors: An Moonen; Vito Annese; Ann Belmans; Albert J Bredenoord; Stanislas Bruley des Varannes; Mario Costantini; Bertrand Dousset; J I Elizalde; Uberto Fumagalli; Marianne Gaudric; Antonio Merla; Andre J Smout; Jan Tack; Giovanni Zaninotto; Olivier R Busch; Guy E Boeckxstaens Journal: Gut Date: 2015-11-27 Impact factor: 23.059
Authors: Jennifer M Kolb; Daniel Jonas; Mateus Pereira Funari; Hazem Hammad; Paul Menard-Katcher; Mihir S Wagh Journal: World J Gastrointest Endosc Date: 2020-12-16