Treatment of achalasia in the bariatric surgery population: a systematic review and single-institution experience
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and Other Interventional Techniques
Treatment of achalasia in the bariatric surgery population: a systematic review and single‑institution experience Trevor D. Crafts1 · Victoria Lyo2 · Priya Rajdev3 · Stephanie G. Wood1 Received: 4 April 2020 / Accepted: 16 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Although the link between achalasia and morbid obesity is unclear, the reported prevalence is 0.5–1% in this population. For bariatric surgery patients, optimal type and timing of achalasia intervention is uncertain. Methods Patient charts from a single academic institution were retrospectively reviewed. Between 2012 and 2019, 245 patients were diagnosed with achalasia, 13 of whom underwent bariatric surgery and were included. Patients were divided into two groups depending on the timing of their achalasia diagnosis and bariatric surgery. Groups were compared in terms of type and timing of intervention as well as treatment response. Results Group 1 included 4 patients diagnosed with achalasia before bariatric surgery. Three had laparoscopic Heller myotomy (LHM) and 1 had a per oral endoscopic myotomy (POEM). These patients had laparoscopic gastric bypass (LGB) within 5 years of achalasia diagnosis. Postoperatively, 1 had severe reflux with regurgitation necessitating radiofrequency energy application to the lower esophageal sphincter. All had relief from dysphagia. Group 2 included 9 patients diagnosed with achalasia after bariatric surgery. Achalasia subtypes were evenly distributed. Initial operations were: 5 LGB, 2 laparoscopic sleeve gastrectomy (LSG), 1 duodenal switch (DS), 1 lap band. One LSG patient was converted to LGB concurrently with LHM. On average, achalasia was diagnosed 8.3 years after bariatric surgery. Achalasia interventions included: 1 pneumatic dilation, 1 Botox injection, 1 POEM, 6 LHM. While LHM was the most common procedure, 4 of 6 patients experienced recurrent dysphagia, one of whom required esophagectomy. Conclusions Achalasia is a challenging problem in the bariatric surgery population. Recurrent symptoms are common. Patients treated for achalasia after bariatric surgery tended to have worse symptom resolution than those diagnosed prior to bariatric surgery. Additional prospective studies are needed to elucidate whether interventions for achalasia should be performed concurrently or in a particular sequence for optimal results. Keywords Achalasia · Bariatric · Dysphagia · Heller · Myotomy · POEM Esophageal motility disorders are uncommon among the general population but have a relatively high incidence in morbidly obese patients. Obesity is a known independent risk factor for esophageal dysmotility and some estimates of prevalence are over 50% [1–3]. With global rates of obesity * Stephanie G. Wood [email protected] 1
Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code: L223A, Portland, OR 97239, USA
2
Department of Surgery, University of California Davis, 2335 Stockton B
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