PDF(Pubmed)
Abstract：
BACKGROUND: Achalasia following bariatric surgery is a rare phenomenon with diverse potential physiopathological origins.
OBJECTIVE: This article aims to explore the hypothetical physiopathological connection between bariatric surgery and the subsequent onset of achalasia.
METHODS: A review was conducted to identify studies reporting cases of peroral endoscopic myotomy (POEM) after bariatric procedures and detailing the outcomes in terms of the technical and clinical success. Additionally, a case of a successful POEM performed on a patient two years after undergoing laparoscopic sleeve gastrectomy (LSG) is presented.
RESULTS: The selection criteria yielded eight studies encompassing 40 patients treated with POEM for achalasia after bariatric surgery: 34 after Roux-en-Y gastric bypass (RYGB) and 6 after LSG. The studies reported an overall technical success rate of 97.5%, with clinical success achieved in 85% of cases. Adverse events were minimal, with only one case of esophageal leak treated endoscopically. However, a postprocedural symptomatic evaluation was notably lacking in most of the included studies.
CONCLUSIONS: Achalasia poses a considerable challenge within the bariatric surgery population. POEM has emerged as a technically viable and safe intervention for this patient demographic, providing an effective treatment option where surgical alternatives for achalasia are limited. Our findings highlight the promising outcomes of POEM in these patients, but the existing data remain limited. Hence, prospective studies are needed to elucidate the optimal pre-surgical assessment and timing of endoscopic procedures for optimizing outcomes.
OBJECTIVE: This article aims to explore the hypothetical physiopathological connection between bariatric surgery and the subsequent onset of achalasia.
METHODS: A review was conducted to identify studies reporting cases of peroral endoscopic myotomy (POEM) after bariatric procedures and detailing the outcomes in terms of the technical and clinical success. Additionally, a case of a successful POEM performed on a patient two years after undergoing laparoscopic sleeve gastrectomy (LSG) is presented.
RESULTS: The selection criteria yielded eight studies encompassing 40 patients treated with POEM for achalasia after bariatric surgery: 34 after Roux-en-Y gastric bypass (RYGB) and 6 after LSG. The studies reported an overall technical success rate of 97.5%, with clinical success achieved in 85% of cases. Adverse events were minimal, with only one case of esophageal leak treated endoscopically. However, a postprocedural symptomatic evaluation was notably lacking in most of the included studies.
CONCLUSIONS: Achalasia poses a considerable challenge within the bariatric surgery population. POEM has emerged as a technically viable and safe intervention for this patient demographic, providing an effective treatment option where surgical alternatives for achalasia are limited. Our findings highlight the promising outcomes of POEM in these patients, but the existing data remain limited. Hence, prospective studies are needed to elucidate the optimal pre-surgical assessment and timing of endoscopic procedures for optimizing outcomes.
摘要：
背景：减肥手术后的贲门失弛缓症是一种罕见的现象，具有多种潜在的生理病理起源。
目的：本文旨在探讨减重手术与随后的门失弛缓症发作之间的假设的生理病理联系。
方法：进行了综述，以确定报告减重手术后经口内镜下肌切开术（POEM）病例的研究，并详细说明技术和临床成功的结果。此外,介绍了在接受腹腔镜袖状胃切除术（LSG）两年后对患者成功进行POEM的情况。
结果：选择标准产生了8项研究，包括40例减重手术后接受POEM治疗的失弛缓症患者：Roux-en-Y胃旁路术（RYGB）后34例，LSG后6例。研究报告的总体技术成功率为97.5%,在85%的病例中取得了临床成功。不良事件很少，只有一例食管漏的内镜治疗。然而,在大多数纳入的研究中,特别缺乏术后对症评估.
结论：失语症在减肥手术人群中提出了相当大的挑战。POEM已成为这种患者人口统计学技术上可行且安全的干预措施，在门失弛缓症的手术选择有限的情况下，提供有效的治疗选择。我们的发现强调了POEM在这些患者中的有希望的结果，但现有数据仍然有限。因此，需要前瞻性研究阐明最佳的术前评估和内镜手术时机,以优化结局.
目的：本文旨在探讨减重手术与随后的门失弛缓症发作之间的假设的生理病理联系。
方法：进行了综述，以确定报告减重手术后经口内镜下肌切开术（POEM）病例的研究，并详细说明技术和临床成功的结果。此外,介绍了在接受腹腔镜袖状胃切除术（LSG）两年后对患者成功进行POEM的情况。
结果：选择标准产生了8项研究，包括40例减重手术后接受POEM治疗的失弛缓症患者：Roux-en-Y胃旁路术（RYGB）后34例，LSG后6例。研究报告的总体技术成功率为97.5%,在85%的病例中取得了临床成功。不良事件很少，只有一例食管漏的内镜治疗。然而,在大多数纳入的研究中,特别缺乏术后对症评估.
结论：失语症在减肥手术人群中提出了相当大的挑战。POEM已成为这种患者人口统计学技术上可行且安全的干预措施，在门失弛缓症的手术选择有限的情况下，提供有效的治疗选择。我们的发现强调了POEM在这些患者中的有希望的结果，但现有数据仍然有限。因此，需要前瞻性研究阐明最佳的术前评估和内镜手术时机,以优化结局.
