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Volume 13
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10.3390/diagnostics13213311
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Case Report

Peroral Endoscopic Myotomy for Achalasia after Bariatric Surgery: A Case Report and Review of the Literature

by
Roberta Maselli
1,2,
Matteo Fiacca
2,3,*,
Gaia Pellegatta
1,
Roberto de Sire
2,4,
Federico De Blasio
2,5,
Antonio Capogreco
1,
Piera Alessia Galtieri
1,
Davide Massimi
1,
Manuela Trotta
1,
Cesare Hassan
1,2 and
Alessandro Repici
1,2
1
Humanitas Clinical and Research Center—IRCCS, 20089 Milan, Italy
2
Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
3
Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy
4
Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II, 80138 Naples, Italy
5
Clinic of Gastroenterology, Hepatology and Emergency Digestive Endoscopy, University Politecnica delle Marche, 60126 Ancona, Italy
*
Author to whom correspondence should be addressed.
Diagnostics 2023, 13(21), 3311; https://doi.org/10.3390/diagnostics13213311
Submission received: 14 September 2023 / Revised: 7 October 2023 / Accepted: 18 October 2023 / Published: 26 October 2023
(This article belongs to the Special Issue Endoscopic Techniques for Diagnosis and Interventions in Digestive Diseases)
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Abstract

Introduction: Achalasia following bariatric surgery is a rare phenomenon with diverse potential physiopathological origins. Aims: This article aims to explore the hypothetical physiopathological connection between bariatric surgery and the subsequent onset of achalasia. Material and Methods: A review was conducted to identify studies reporting cases of peroral endoscopic myotomy (POEM) after bariatric procedures and detailing the outcomes in terms of the technical and clinical success. Additionally, a case of a successful POEM performed on a patient two years after undergoing laparoscopic sleeve gastrectomy (LSG) is presented. Results: The selection criteria yielded eight studies encompassing 40 patients treated with POEM for achalasia after bariatric surgery: 34 after Roux-en-Y gastric bypass (RYGB) and 6 after LSG. The studies reported an overall technical success rate of 97.5%, with clinical success achieved in 85% of cases. Adverse events were minimal, with only one case of esophageal leak treated endoscopically. However, a postprocedural symptomatic evaluation was notably lacking in most of the included studies. Conclusions: Achalasia poses a considerable challenge within the bariatric surgery population. POEM has emerged as a technically viable and safe intervention for this patient demographic, providing an effective treatment option where surgical alternatives for achalasia are limited. Our findings highlight the promising outcomes of POEM in these patients, but the existing data remain limited. Hence, prospective studies are needed to elucidate the optimal pre-surgical assessment and timing of endoscopic procedures for optimizing outcomes.
Keywords: bariatric surgery; achalasia; dysphagia; POEM bariatric surgery; achalasia; dysphagia; POEM

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MDPI and ACS Style

Maselli, R.; Fiacca, M.; Pellegatta, G.; de Sire, R.; De Blasio, F.; Capogreco, A.; Galtieri, P.A.; Massimi, D.; Trotta, M.; Hassan, C.; et al. Peroral Endoscopic Myotomy for Achalasia after Bariatric Surgery: A Case Report and Review of the Literature. Diagnostics 2023, 13, 3311. https://doi.org/10.3390/diagnostics13213311

AMA Style

Maselli R, Fiacca M, Pellegatta G, de Sire R, De Blasio F, Capogreco A, Galtieri PA, Massimi D, Trotta M, Hassan C, et al. Peroral Endoscopic Myotomy for Achalasia after Bariatric Surgery: A Case Report and Review of the Literature. Diagnostics. 2023; 13(21):3311. https://doi.org/10.3390/diagnostics13213311

Chicago/Turabian Style

Maselli, Roberta, Matteo Fiacca, Gaia Pellegatta, Roberto de Sire, Federico De Blasio, Antonio Capogreco, Piera Alessia Galtieri, Davide Massimi, Manuela Trotta, Cesare Hassan, and et al. 2023. "Peroral Endoscopic Myotomy for Achalasia after Bariatric Surgery: A Case Report and Review of the Literature" Diagnostics 13, no. 21: 3311. https://doi.org/10.3390/diagnostics13213311

APA Style

Maselli, R., Fiacca, M., Pellegatta, G., de Sire, R., De Blasio, F., Capogreco, A., Galtieri, P. A., Massimi, D., Trotta, M., Hassan, C., & Repici, A. (2023). Peroral Endoscopic Myotomy for Achalasia after Bariatric Surgery: A Case Report and Review of the Literature. Diagnostics, 13(21), 3311. https://doi.org/10.3390/diagnostics13213311

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