Gianfranco Donatelli1, Fabrizio Cereatti2, Antoine Soprani3. 1. Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, 8 Place de l'Abbé G. Hénocque 75013 Ramsay Santé, Paris, France. donatelligianfranco@gmail.com. 2. Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, 8 Place de l'Abbé G. Hénocque 75013 Ramsay Santé, Paris, France. 3. Service de Chirurgie Digestive, Clinique Geoffroy Saint Hilaire, Ramsay Santé, Paris, France.
Abstract
INTRODUCTION: Achalasia after bariatric surgery is a rare pathological entity. Nonetheless, several cases have been described in literature. Per oral endoscopic myotomy has recently emerged as the preferred approach for the management of esophageal motility disorders. MATERIAL AND METHODS: We report a video case of POEM performed in a female patient with prior multiple bariatric surgical procedures. In her past medical history, she underwent to laparoscopic lap band, sleeve gastrectomy, and Roux-Y-gastric bypass. RESULTS: POEM was carried out without complication. Myotomy was performed only for 1 cm below the cardias due to the presence of the gastro-jejunal anastomosis. Post-operative course was uneventful and oral diet was restarted after one day. At 2 months follow-up, the patient is asymptomatic with no weight regain. CONCLUSION: We report the first case of POEM after three different bariatric surgical procedure. Fibrosis due to prior interventions did not hampered POEM procedure, and the shorter myotomy due to the presence of small gastric pouch did not reduced its efficacy.
INTRODUCTION:Achalasia after bariatric surgery is a rare pathological entity. Nonetheless, several cases have been described in literature. Per oral endoscopic myotomy has recently emerged as the preferred approach for the management of esophageal motility disorders. MATERIAL AND METHODS: We report a video case of POEM performed in a female patient with prior multiple bariatric surgical procedures. In her past medical history, she underwent to laparoscopic lap band, sleeve gastrectomy, and Roux-Y-gastric bypass. RESULTS: POEM was carried out without complication. Myotomy was performed only for 1 cm below the cardias due to the presence of the gastro-jejunal anastomosis. Post-operative course was uneventful and oral diet was restarted after one day. At 2 months follow-up, the patient is asymptomatic with no weight regain. CONCLUSION: We report the first case of POEM after three different bariatric surgical procedure. Fibrosis due to prior interventions did not hampered POEM procedure, and the shorter myotomy due to the presence of small gastric pouch did not reduced its efficacy.
Entities:
Keywords:
Achalasia; Gastric By Pass; Lap Band; Megaesophagus; POEM; Sleeve Gastrectomy; myotomy
Authors: G Silecchia; A Restuccia; U Elmore; D Polito; N Perrotta; A Genco; V Bacci; N Basso Journal: Surg Laparosc Endosc Percutan Tech Date: 2001-08 Impact factor: 1.719