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Esophageal achalasia after Roux-en-Y gastric bypass for morbid obesity

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Abstract

The development of achalasia in patients with a prior Roux-en-Y gastric bypass (RYGB) is rare and it often remains unclear whether the esophageal motility disorder is a pre-existing condition in the obese patient or develops de novo after the procedure. The aim of this study was to review the available evidence regarding the management of patients with achalasia after a RYGB. Intra-sphincteric injection of botulinum toxin and pneumatic dilatation can be used to eliminate the functional obstruction at the level of the gastroesophageal junction. However, considering that achalasia patients after RYGB are often young and these treatment modalities have shown worse long-term outcomes, endoscopic or surgical myotomy is preferred. Per-oral endoscopic myotomy (POEM) is a very effective first line of treatment, and as RYGB is an excellent anti-reflux operation per se, post-POEM reflux may not be an issue in these patients. Laparoscopic Heller myotomy (LHM) is also an effective and safe therapy in achalasia patients with RYGB anatomy, and the gastric remnant can be safely used to perform a fundoplication to cover the myotomy. LHM and POEM are both acceptable primary treatment modalities in this setting. Further studies are needed to elucidate the pathophysiology and optimal management of patients with achalasia after RYGB.

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Authors and Affiliations

  1. Department of Surgery, Hospital Alemán of Buenos Aires, University of Buenos Aires, Av. Pueyrredón 1640, ATT 1118, Buenos Aires, Argentina

    María A. Casas, Francisco Schlottmann & Rudolf Buxhoeveden

  2. Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil

    Fernando A. M. Herbella

  3. Department of Medicine and Surgery, University of North Carolina, Chapel Hill, NC, USA

    Marco G. Patti

Authors
  1. María A. Casas
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  2. Francisco Schlottmann
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  3. Fernando A. M. Herbella
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  4. Rudolf Buxhoeveden
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  5. Marco G. Patti
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Correspondence to Francisco Schlottmann.

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María A. Casas declares that she has no conflict of interest. Francisco Schlottmann declares that he has no conflict of interest. Fernando A.M Herbella declares that he has no conflict of interest. Rudolf Buxhoeveden declares that he has no conflict of interest. Marco G. Patti declares that he has no conflict of interest.

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Casas, M.A., Schlottmann, F., Herbella, F.A.M. et al. Esophageal achalasia after Roux-en-Y gastric bypass for morbid obesity. Updates Surg 71, 631–635 (2019). https://doi.org/10.1007/s13304-019-00688-3

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  • DOI: https://doi.org/10.1007/s13304-019-00688-3

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