Endoscopy 2019; 51(04): 342-345
DOI: 10.1055/a-0656-5530
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Peroral endoscopic myotomy for the treatment of achalasia patients with Roux-en-Y gastric bypass anatomy

Omid Sanaei
1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
,
Peter Draganov
2  Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
,
Rastislav Kunda
3  Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
,
Dennis Yang
2  Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
,
Mouen A. Khashab
1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
› Author Affiliations
Further Information

Publication History

submitted 21 January 2018

accepted after revision 25 June 2018

Publication Date:
01 August 2018 (eFirst)

Abstract

Background The outcome of peroral endoscopic myotomy (POEM) in patients with prior Roux-en-Y gastric bypass (RYGB) is not known and some experts have recommended against its performance in this patient population because of the risk of postoperative regurgitation. The aim of this study was to report on the outcomes of POEM in patients with RYGB anatomy.

Methods Patients with RYGB anatomy who underwent POEM for the treatment of achalasia at three tertiary centers were included. POEM was performed in standard fashion using the anterior or posterior approach. Clinical response was defined by a decrease in Eckardt score to ≤ 3. Results of esophageal acid exposure testing/pH-impedance and manometric testing after POEM were reported when available.

Results A total of 10 achalasia patients with prior RYGB surgery underwent POEM. All procedures were technically successful with anterior myotomy performed in seven patients. The mean submucosal tunnel length and myotomy length were 12.9 cm and 11.1 cm, respectively. The mean procedure time was 72 minutes and mean length of hospital stay was 1.5 days. Clinical success was achieved in all 10 patients with a significant decrease in Eckardt score from 6.5 to 1 (P < 0.001). None of the patients experienced post-procedural regurgitation. Post-procedural pH testing was obtained in six patients and was normal in all of them.

Conclusions This study suggests the feasibility, safety, and efficacy of POEM in patients with prior RYGB surgery. The risk of gastroesophageal reflux disease in these patients seems to be minimal after POEM.