Outcomes of peroral endoscopic myotomy in patients with achalasia and prior bariatric surgery: A multicenter experience

S. Bomman; J. S. Klair; M. Ashat; R. El Abiad; H. Gerke; J. Keech; K. Parekh; P. Nau; Y. Hanada; L M Wong Kee Song; R. Kozarek; S. Irani; D. Low; A. Ross; R. Krishnamoorthi

doi:10.1093/dote/doab044

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Outcomes of peroral endoscopic myotomy in patients with achalasia and prior bariatric surgery: A multicenter experience

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Outcomes of peroral endoscopic myotomy in patients with achalasia and prior bariatric surgery: A multicenter experience

S. Bomman, J. S. Klair, M. Ashat, R. El Abiad, H. Gerke, J. Keech, K. Parekh, P. Nau, Y. Hanada, L M Wong Kee Song, …

Diseases of the esophagus, Vol.34(12), doab044

12/01/2021

DOI: 10.1093/dote/doab044

PMID: 34184036

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Abstract

Peroral endoscopicmyotomy (POEM) in patients with achalasia who are status post bariatric surgery may be technically challenging due to postsurgical scarring and altered anatomy. The aim of the study was to assess the efficacy and safety of POEM for achalasia in patients with prior bariatric surgery. A review of prospectively maintained databases at three tertiary referral centers from January 2015 to January 2021 was performed. The primary outcome of interest was clinical success, defined as a post-treatment Eckardt score = 3 or improvement in Eckardt score by = 1 when the baseline score was <3, and improvement of symptoms. Secondary outcomes were adverse event rates and symptom recurrence. Sixteen patients status post Roux-en-Y gastric bypass (n= 14) and sleeve gastrectomy (n= 2) met inclusion criteria. Indications for POEM were achalasia type I (n= 2), type II (n= 9), and type III (n= 5). POEM was performed either by anterior or posterior approach. The pre-POEM mean integrated relaxation pressure was 26.2 +/- 7.6 mm Hg. The mean total myotomy length was 10.2 +/- 2.7 cm. The mean length of hospitalization was 1.4 +/- 0.7 days. Pre- and postprocedure Eckardt scores were 6.1 +/- 2.1 and 1.7 +/- 1.8, respectively. The overall clinical success rate was 93.8% (15/16) with mean follow-up duration of 15.5 months. One patient had esophageal leak on postprocedure esophagram and managed endoscopically. Dysphagia recurred in two patients, which was successfully managed with pneumatic dilation with or without botulinum toxin injection. POEM appears to be safe and effective in the management of patients with achalasia who have undergone prior bariatric surgery.

Gastroenterology & Hepatology

Life Sciences & Biomedicine

Science & Technology

Details

Title: Subtitle: Outcomes of peroral endoscopic myotomy in patients with achalasia and prior bariatric surgery: A multicenter experience
Creators: S. Bomman - Virginia Mason Medical Center
J. S. Klair - Virginia Mason Medical Center
M. Ashat - University of Iowa
R. El Abiad - University of Iowa
H. Gerke - University of Iowa
J. Keech - University of Iowa
K. Parekh - University of Iowa Hospitals and Clinics
P. Nau - University of Iowa Hospitals and Clinics
Y. Hanada - Mayo Clinic in Arizona
L M Wong Kee Song - Mayo Clinic in Arizona
R. Kozarek - Virginia Mason Medical Center
S. Irani - Virginia Mason Medical Center
D. Low - Virginia Mason Medical Center
A. Ross - Virginia Mason Medical Center
R. Krishnamoorthi - Virginia Mason Medical Center
Resource Type: Journal article
Publication Details: Diseases of the esophagus, Vol.34(12), doab044
DOI: 10.1093/dote/doab044
PMID: 34184036
NLM abbreviation: Dis Esophagus
ISSN: 1120-8694
eISSN: 1442-2050
Publisher: Oxford Univ Press
Number of pages: 6
Language: English
Date published: 12/01/2021
Academic Unit: Anatomy and Cell Biology; Gastroenterology and Hepatology; Surgery; Cardiothoracic Surgery; Internal Medicine
Record Identifier: 9984284330802771

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