Achalasia after bariatric Roux-en-Y gastric bypass surgery reversal

Table 1 Reported cases of achalasia after Roux-en-Y gastric bypass

Case	Age and gender	Pre-operative BMI (kg/m2)	Procedure	Presentation	Onset of symptoms postoperative	Upper GI series/Barium swallow	EGD	Esophageal manometry	Treatment
Ramos et al[16] 2009	44-yr-old female	47	Laparoscopic RYGB	Dysphagia to solids, and regurgitation	4 yr	Dilated	Normal gastroesophageal	Elevated resting LES pressure, aperistalsis, and hypo contractility	Laparoscopic Heller myotomy
						esophagus, poor esophageal emptying, and	junction, a 4-cm gastric pouch without lesions, and a wide	of the esophagus.
						tapering of the LES	gastrojejunostomy
Torghabeh et al[17] 2015	48-yr-old female	44.75	Laparoscopic RYGB	Dysphagia to solid, regurgitation, and chest pain	5 yr	Dilated esophagus and stricture at the LES	Tortuous esophagus with retained food products and Candida plaques. Stricture was balloon dilated	Elevated resting LES pressure, aperistalsis, and failure of LES relaxation	Laparoscopic Heller myotomy
Chapman et al[18] 2013	53-yr-old female	NA	Open PYGB	Epigastric and LUQ pain and reflux symptoms	2 yr	Dilated thoracic esophagus with reduced primary peristalsis. Contrast was slow to pass through the gastro-esophageal junction	Dilated esophagus, esophagitis and ulceration above the gastro-esophageal junction	Absence of LES relaxation and aperistalsis	Laparoscopic Heller myotomy
Our case 2016	70-yr-old female	52	Laparoscopic RYGB	Regurgitation, mild dysphagia, nausea and occasional vomiting	2 yr	Persistent narrowing of the gastroesophageal junction with a dilated, debris filled esophagus. Some tertiary contractions	Dilated, tortuous esophagus that appeared as a "sigmoid esophagus" but no strictures or stenosis was noted.	Elevated LES pressure with abnormal relaxation in addition to aperistalsis and	Scheduled for laparoscopic Heller myotomy

LES: Lower esophageal sphincter.