Aims:
Gastric torsion is and uncommom complication after sleeve gastrectomy leading to food
intolerance and abdominal pain. The stablished treatment is surgical adhecens resolution.
Achalasia baloon dilatation or stenting has been describedWe present acalinical case
of a patient with gastric torsion after 6 months of sleeve gastrectomy unresponsive
to endoscopic treatment.
Methods:
The proposed treatment was to perform a gastric POEM to cut the adhecens through a
gastric submucosa tunnel. The critical area was incisura angularis. Submucosal long
tunnel was confectioned from 8 cms above critical area. Total tunnel lenght was 14
cms. Suture gastric line scar tissue was liberated from submucosa and gastric muscle
with a endoscopic knife entering peritoneal cavity.
Results:
Resolution of the restriction was inmediatly achived. Mucosotomy was close with clips.
Evolution was excelent. The patient was discharged from the hospital 1 day after with
peroral clear liquids. Diet was advanced to solid after 5 days. No adverse event ocurred.
Follow up is 10 months and the patient remains asymptomatic.
Conclusion:
GPOEM could be considered as an alternative rescue therapy for gastric torsion after
sleeve gastrectomy.
