Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2020; 12(12): 532-541
Published online Dec 16, 2020. doi: 10.4253/wjge.v12.i12.532
Efficacy and safety of peroral endoscopic myotomy after prior sleeve gastrectomy and gastric bypass surgery
Jennifer M Kolb, Daniel Jonas, Mateus Pereira Funari, Hazem Hammad, Paul Menard-Katcher, Mihir S Wagh
Jennifer M Kolb, Hazem Hammad, Paul Menard-Katcher, Division of Gastroenterology, University of Colorado-Denver, Aurora, CO 80045, United States
Daniel Jonas, Department of Internal Medicine, University of Colorado Hospital, Aurora, CO 80045, United States
Mateus Pereira Funari, Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São paulo 05403000, São paulo, Brazil
Mihir S Wagh, Interventional Endoscopy, Division of Gastroenterology, University of Colorado-Denver, Aurora, CO 80045, United States
Author contributions: Wagh MS contributed conception of the study; Kolb JM and Jonas D contributed acquisition of data; Kolb JM contributed analysis and interpretation of data, drafting of the manuscript; Kolb JM, Funari MP, Hammad H, Menard-Katcher P and Wagh MS contributed critical revisions of the manuscript and final approval of the version of the article to be published.
Institutional review board statement: The study was reviewed and approved by the Colorado Multiple Institutional Review Board (Approval No. CRV002-1).
Informed consent statement: As per the institutional review board, a waiver of consent was provided for this retrospective chart review.
Conflict-of-interest statement: Wagh MS is a consultant for Boston Scientific, Medtronic and Olympus; Hammad H is a consultant for Olympus, Boston Scientific, and Covidien; Kolb JM, Jonas D, Funari MP, Menard-Katcher P have no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mihir S Wagh, FACG, FASGE, MD, Associate Professor, Interventional Endoscopy, Division of Gastroenterology, University of Colorado-Denver, 1635 Aurora Court, F735, Aurora, CO 80045, United States. mihir.wagh@cuanschutz.edu
Received: August 10, 2020
Peer-review started: August 10, 2020
First decision: September 17, 2020
Revised: October 10, 2020
Accepted: November 29, 2020
Article in press: November 29, 2020
Published online: December 16, 2020
Processing time: 125 Days and 4.6 Hours
Abstract
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.

Keywords: Obesity; Bariatric surgery; Achalasia; Peroral endoscopic myotomy; Sleeve gastrectomy; Gastric bypass

Core Tip: There is limited data on performance of per-oral endoscopic myotomy (POEM) in patients with altered upper gastrointestinal anatomy, especially after bariatric surgery. To our knowledge, performance and outcomes of POEM have not been reported after sleeve gastrectomy, which is the most common surgical bariatric procedure. Given the worldwide epidemic of obesity, gastroenterologists may be increasingly faced with achalasia after bariatric surgery, for which POEM may be a viable endoscopic option. Our results show that POEM can be safely performed for achalasia in the setting of prior bariatric surgery and offers a safe and effective treatment for these patients with limited surgical options.