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

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 revie...

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Autores principales: Maselli, Roberta, Fiacca, Matteo, Pellegatta, Gaia, de Sire, Roberto, De Blasio, Federico, Capogreco, Antonio, Galtieri, Piera Alessia, Massimi, Davide, Trotta, Manuela, Hassan, Cesare, Repici, Alessandro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10647658/
https://www.ncbi.nlm.nih.gov/pubmed/37958207
http://dx.doi.org/10.3390/diagnostics13213311
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author Maselli, Roberta
Fiacca, Matteo
Pellegatta, Gaia
de Sire, Roberto
De Blasio, Federico
Capogreco, Antonio
Galtieri, Piera Alessia
Massimi, Davide
Trotta, Manuela
Hassan, Cesare
Repici, Alessandro
author_facet Maselli, Roberta
Fiacca, Matteo
Pellegatta, Gaia
de Sire, Roberto
De Blasio, Federico
Capogreco, Antonio
Galtieri, Piera Alessia
Massimi, Davide
Trotta, Manuela
Hassan, Cesare
Repici, Alessandro
author_sort Maselli, Roberta
collection PubMed
description 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.
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spelling pubmed-106476582023-10-26 Peroral Endoscopic Myotomy for Achalasia after Bariatric Surgery: A Case Report and Review of the Literature Maselli, Roberta Fiacca, Matteo Pellegatta, Gaia de Sire, Roberto De Blasio, Federico Capogreco, Antonio Galtieri, Piera Alessia Massimi, Davide Trotta, Manuela Hassan, Cesare Repici, Alessandro Diagnostics (Basel) Case Report 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. MDPI 2023-10-26 /pmc/articles/PMC10647658/ /pubmed/37958207 http://dx.doi.org/10.3390/diagnostics13213311 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Maselli, Roberta
Fiacca, Matteo
Pellegatta, Gaia
de Sire, Roberto
De Blasio, Federico
Capogreco, Antonio
Galtieri, Piera Alessia
Massimi, Davide
Trotta, Manuela
Hassan, Cesare
Repici, Alessandro
Peroral Endoscopic Myotomy for Achalasia after Bariatric Surgery: A Case Report and Review of the Literature
title Peroral Endoscopic Myotomy for Achalasia after Bariatric Surgery: A Case Report and Review of the Literature
title_full Peroral Endoscopic Myotomy for Achalasia after Bariatric Surgery: A Case Report and Review of the Literature
title_fullStr Peroral Endoscopic Myotomy for Achalasia after Bariatric Surgery: A Case Report and Review of the Literature
title_full_unstemmed Peroral Endoscopic Myotomy for Achalasia after Bariatric Surgery: A Case Report and Review of the Literature
title_short Peroral Endoscopic Myotomy for Achalasia after Bariatric Surgery: A Case Report and Review of the Literature
title_sort peroral endoscopic myotomy for achalasia after bariatric surgery: a case report and review of the literature
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10647658/
https://www.ncbi.nlm.nih.gov/pubmed/37958207
http://dx.doi.org/10.3390/diagnostics13213311
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