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

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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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Authors and Affiliations

  1. Department of Biomedical Science for Health, Division of General Surgery, Istitituto Clinico Sant’Ambrogio, University of Milan, Milan, Italy

    Alberto Aiolfi, Stefania Tornese, Gianluca Bonitta, Emanuele Rausa & Davide Bona

  2. Department of Pathophysiology and Transplantation, INCO and Department of General Surgery, Istituto Clinico Sant’Ambrogio, University of Milan, Milan, Italy

    Giancarlo Micheletto

Authors
  1. Alberto Aiolfi
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  2. Stefania Tornese
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  3. Gianluca Bonitta
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  4. Emanuele Rausa
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  5. Giancarlo Micheletto
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  6. Davide Bona
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Contributions

AA, ST, and ER did the literature search.

AA and DB formed the study design.

Data collection is done by A.A, ST, ER, and D.B.

AA and GB analyzed the data.

AA, GB, and DB interpreted the data.

AA wrote the manuscript.

AA, GM, and DB critically reviewed the manuscript.

Corresponding author

Correspondence to Alberto Aiolfi.

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The authors declare that they have no conflict of interest.

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Not applicable.

Research Involving Human Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Aiolfi, A., Tornese, S., Bonitta, G. et al. Management of Esophageal Achalasia after Roux-en-Y Gastric Bypass: Narrative Review of the Literature. OBES SURG 29, 1632–1637 (2019). https://doi.org/10.1007/s11695-019-03774-y

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