Kolb JM, Jonas D, Funari MP, Hammad H, Menard-Katcher P, Wagh MS. Efficacy and safety of peroral endoscopic myotomy after prior sleeve gastrectomy and gastric bypass surgery. World J Gastrointest Endosc 2020; 12(12): 532-541 [PMID: 33362906 DOI: 10.4253/wjge.v12.i12.532]
Corresponding Author of This Article
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
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
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.
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
ARTICLE HIGHLIGHTS
Research background
Per-oral endoscopic myotomy (POEM) is a safe and effective treatment for achalasia, but in patients with prior bariatric surgery the altered gastrointestinal tract anatomy can pose a technical challenge.
Research motivation
Currently there is sparse published data on efficacy and feasibility of POEM in patients with prior Roux-en-Y gastric bypass (RYGB) and no published reports in patients with prior sleeve gastrectomy (SG).
Research objectives
To describe the safety, feasibility and clinical outcomes of POEM in patients with history of bariatric surgery.
Research methods
Six patients with prior bariatric surgery who underwent POEM for achalasia were included. Technical success defined as the ability to successfully complete the procedure and clinical success defined as a post procedure Eckardt score ≤ 3 were evaluated. Adverse events were recorded for safety outcomes.
Research results
Six patients (50% male, mean age 48 years) with a history of prior bariatric surgery (3 RYGB, 3 SG) underwent POEM. Four patients had Achalasia Type II and two had Achalasia Type 1. Technical success was 100%. Clinical success was achieved in 4 (67%) patients at mean follow-up of 21 mo. One clinical failure was likely a result of candida esophagitis causing dysphagia since EndoFLIP demonstrated adequate myotomy. There were no major adverse events.
Research conclusions
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.
Research perspectives
Future prospective studies are needed to compare outcomes in patients undergoing POEM after RYGB vs SG and to define predictors for clinical success.
