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Obesity Surgery
Published in: Obesity Surgery 5/2019

01-05-2019 | Motility Disorder | Original Contributions

Management of Esophageal Achalasia after Roux-en-Y Gastric Bypass: Narrative Review of the Literature

Authors: Alberto Aiolfi, Stefania Tornese, Gianluca Bonitta, Emanuele Rausa, Giancarlo Micheletto, Davide Bona

Published in: Obesity Surgery | Issue 5/2019

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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.
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Metadata
Title
Management of Esophageal Achalasia after Roux-en-Y Gastric Bypass: Narrative Review of the Literature
Authors
Alberto Aiolfi
Stefania Tornese
Gianluca Bonitta
Emanuele Rausa
Giancarlo Micheletto
Davide Bona
Publication date
01-05-2019
Publisher
Springer US
Published in
Obesity Surgery / Issue 5/2019
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-019-03774-y

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