Efficacy and safety of peroral endoscopic myotomy after prior sleeve gastrectomy and gastric bypass surgery.
Achalasia
Bariatric surgery
Gastric bypass
Obesity
Peroral endoscopic myotomy
Sleeve gastrectomy
Journal
World journal of gastrointestinal endoscopy
ISSN: 1948-5190
Titre abrégé: World J Gastrointest Endosc
Pays: United States
ID NLM: 101532474
Informations de publication
Date de publication:
16 Dec 2020
16 Dec 2020
Historique:
received:
10
08
2020
revised:
10
10
2020
accepted:
29
11
2020
entrez:
28
12
2020
pubmed:
29
12
2020
medline:
29
12
2020
Statut:
ppublish
Résumé
Per-oral endoscopic myotomy (POEM) is safe and effective for the treatment of achalasia. There is limited data on performance of POEM in patients with altered upper gastrointestinal anatomy, especially after bariatric surgery. Outcomes in patients with prior sleeve gastrectomy have not been reported. To assess the efficacy and safety of POEM in patients with prior bariatric surgery. A prospective POEM database was reviewed from 3/2017-5/2020 to identify patients who underwent POEM after prior bariatric surgery. Efficacy was assessed by technical success (defined as the ability to successfully complete the procedure) and clinical success [decrease in Eckardt score (ES) to ≤ 3 post procedure]. Safety was evaluated by recording adverse events. Six patients (50% male, mean age 48 years) with a history of prior bariatric surgery who underwent POEM were included. Three had prior sleeve gastrectomy (SG) and three prior Roux-en-Y gastric bypass (RYGB). Four patients had achalasia subtype II and 2 had type I. Most (4) patients had undergone previous achalasia therapy. Technical success was 100%. Clinical success was achieved in 4 (67%) patients at mean follow-up of 21 mo. In one of the clinical failures, EndoFLIP evaluation demonstrated adequate treatment and candida esophagitis was noted as the likely cause of dysphagia. There were no major adverse events. POEM is technically feasible after both RYGB and SG and offers an effective treatment for this rare group of patients where surgical options for achalasia are limited.
Sections du résumé
BACKGROUND
BACKGROUND
Per-oral endoscopic myotomy (POEM) is safe and effective for the treatment of achalasia. There is limited data on performance of POEM in patients with altered upper gastrointestinal anatomy, especially after bariatric surgery. Outcomes in patients with prior sleeve gastrectomy have not been reported.
AIM
OBJECTIVE
To assess the efficacy and safety of POEM in patients with prior bariatric surgery.
METHODS
METHODS
A prospective POEM database was reviewed from 3/2017-5/2020 to identify patients who underwent POEM after prior bariatric surgery. Efficacy was assessed by technical success (defined as the ability to successfully complete the procedure) and clinical success [decrease in Eckardt score (ES) to ≤ 3 post procedure]. Safety was evaluated by recording adverse events.
RESULTS
RESULTS
Six patients (50% male, mean age 48 years) with a history of prior bariatric surgery who underwent POEM were included. Three had prior sleeve gastrectomy (SG) and three prior Roux-en-Y gastric bypass (RYGB). Four patients had achalasia subtype II and 2 had type I. Most (4) patients had undergone previous achalasia therapy. Technical success was 100%. Clinical success was achieved in 4 (67%) patients at mean follow-up of 21 mo. In one of the clinical failures, EndoFLIP evaluation demonstrated adequate treatment and candida esophagitis was noted as the likely cause of dysphagia. There were no major adverse events.
CONCLUSION
CONCLUSIONS
POEM is technically feasible after both RYGB and SG and offers an effective treatment for this rare group of patients where surgical options for achalasia are limited.
Identifiants
pubmed: 33362906
doi: 10.4253/wjge.v12.i12.532
pmc: PMC7739145
doi:
Types de publication
Journal Article
Langues
eng
Pagination
532-541Informations de copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflict-of-interest statement: Wagh MS is a consultant for Boston Scientific, Medtronic and Olympus; Hammad H is a consultant for Olympus, Boston Scientific, and Covidien; Kolb JM, Jonas D, Funari MP, Menard-Katcher P have no conflict of interest.
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