Esophageal achalasia after Roux-en-Y gastric bypass for morbid obesity
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The development of achalasia in patients with a prior Roux-en-Y gastric bypass (RYGB) is rare and it often remains unclear whether the esophageal motility disorder is a pre-existing condition in the obese patient or develops de novo after the procedure. The aim of this study was to review the available evidence regarding the management of patients with achalasia after a RYGB. Intra-sphincteric injection of botulinum toxin and pneumatic dilatation can be used to eliminate the functional obstruction at the level of the gastroesophageal junction. However, considering that achalasia patients after RYGB are often young and these treatment modalities have shown worse long-term outcomes, endoscopic or surgical myotomy is preferred. Per-oral endoscopic myotomy (POEM) is a very effective first line of treatment, and as RYGB is an excellent anti-reflux operation per se, post-POEM reflux may not be an issue in these patients. Laparoscopic Heller myotomy (LHM) is also an effective and safe therapy in achalasia patients with RYGB anatomy, and the gastric remnant can be safely used to perform a fundoplication to cover the myotomy. LHM and POEM are both acceptable primary treatment modalities in this setting. Further studies are needed to elucidate the pathophysiology and optimal management of patients with achalasia after RYGB.
KeywordsObesity Gastric bypass Achalasia POEM Heller myotomy
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Conflict of interest
María A. Casas declares that she has no conflict of interest. Francisco Schlottmann declares that he has no conflict of interest. Fernando A.M Herbella declares that he has no conflict of interest. Rudolf Buxhoeveden declares that he has no conflict of interest. Marco G. Patti declares that he has no conflict of interest.
Human and animal rights
This study does not contain any studies with human participants performed by any of the authors.
No informed consent was needed for this review article.