Efficacy and safety of peroral endoscopic myotomy after prior sleeve gastrectomy and gastric bypass surgery

• 作者: Daniel Jonas Hazem Hammad Jennifer M Kolb Mateus Pereira Funari Mihir S Wagh Paul Menard-Katcher
• 来源期刊: 世界胃肠内镜杂志:英文版(电子版)
• 学科: 医学
• 关键词: OBESITY Bariatric surgery ACHALASIA Peroral endoscopic myotomy Sleeve gastrectomy Gastric bypass
• 年，卷（期）: 2020,（12）
• 页码范围: 532-541
• 页数: 10页
• 分类号: R73

摘要

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 To assess the efficacy and safety of POEM in patients with prior bariatric surgery.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 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 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.