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

Table 1 Clinical characteristics of patients with a history of bariatric surgery who underwent peroral endoscopic myotomy

Case	Age Sex	Type of bariatric surgery	Pre-POEM Eckardt Score	Achalasia subtype	IRP (normal < 15)	Prior achalasia treatment1	Months from bariatric surgery to POEM
1	54 M	SG	9	1	NA2	Heller myotomy	47
2	68 M	SG	6	2	22.2	Botulinum toxin injection	71
3	53 F	SG	7	1	23.7	Botulinum toxin injection; Heller myotomy3	165
4	43 F	RYGB	10	2	21.2	None	96
5	31 M	RYGB	44	2	28	Botulinum toxin injection	84
6	37 F	RYGB	10	2	36	None	122

¹Standard endoscopic dilation ≤ 20 mm was not considered as a prior achalasia treatment.

²Probe was not able to be passed beyond the esophagogastric junction, however there was complete aperistalsis consistent with achalasia with prior treatment with Heller myotomy.

³Aborted due to adhesions.

⁴Achalasia diagnosis preceded bariatric surgery. In all other cases achalasia was diagnosed after bariatric surgery. Eckardt score comprised of dysphagia (2) and regurgitation (2) without weight loss. M: Male; F: Female; SG: Sleeve gastrectomy; RYGB: Roux-en-Y gastric bypass; ES: Eckardt Score; IRP: Integrated relaxation pressure of the lower esophageal sphincter (mmHg) as measured by high-resolution esophageal manometry. POEM: Peroral endoscopic myotomy; NA: Not available.