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Obesity Surgery
Published in: Obesity Surgery 11/2019

01-11-2019 | Obesity | Original Contributions

Peroral Endoscopic Myotomy Is Feasible and Safe in a Gastric Bypass Population

Authors: Umair Bashir, Rami El Abiad, Henning Gerke, John Keech, Kalpaj Parekh, Peter Nau

Published in: Obesity Surgery | Issue 11/2019

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Abstract

Background

Obesity is public health problem of epidemic proportions. Esophageal dysmotility including achalasia is more commonly seen in an obese population. Standard therapy for achalasia can be complicated by hepatomegaly and a post-surgical anatomy in a pre- and post-bariatric population. Peroral endoscopic myotomy (POEM) has not been adequately studied in this population.

Methods

A retrospective review of a prospectively collected database was completed. Patients who had undergone a Roux-en-y gastric bypass (RYGB) prior to or following a POEM were enrolled. Patient demographics, operative information and post-operative course data was collected.

Results

Six patients underwent POEM prior to or after RYGB. There were no peri-operative complications with an average length of stay of 1.2 days. Five patients experienced a clinical success with excellent symptom resolution. The one failure was in the setting of type III achalasia, but did have objective evidence of lower esophageal sphincter (LES) relaxation post-operatively.

Conclusion

POEM in the setting of bariatric surgery is safe and feasible. The potential increase in GERD following POEM is obviated by RYGB anatomy. In an obese individual, a staged POEM prior to or following a RYGB is an appropriate treatment algorithm for obese and achalasia.
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Metadata
Title
Peroral Endoscopic Myotomy Is Feasible and Safe in a Gastric Bypass Population
Authors
Umair Bashir
Rami El Abiad
Henning Gerke
John Keech
Kalpaj Parekh
Peter Nau
Publication date
01-11-2019
Publisher
Springer US
Published in
Obesity Surgery / Issue 11/2019
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-019-04026-9

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