Background

Achalasia after Roux-en-Y gastric bypass (RYGB) is a rare complication, happening years after surgery. Laparoscopic Heller Myotomy (LHM) and Peroral Endoscopic Myotomy (POEM) are frequently used techniques to treat achalasia. The purpose of this narrative review is to summarize the available evidence of achalasia treatment post-RYGB, and to specifically compare post-operative complications of LHM versus POEM.

Methods

Case reports and review articles with achalasia listed as a post-operative complication were compiled (from PubMed).

Results

Our literature review reveled twenty-four studies for a total of 65 included patients. The patients’ age range at time of achalasia development was from 28 to 70 years with a mean age of 53 years. Only 60 patients in the literature had their gender reported, with 80% being female. Overall, 77% of patients had undergone LRYGB while the remaining 23% underwent open RYGB. The onset of achalasia symptoms post RYGB was highly variable, ranging from immediate onset to 18 years post op (mean onset of 7.2 years). Of the patients with reported achalasia subtypes, 12 patients presented with Type 1, 20 patients with Type 2, and 6 patients with Type 3. For treatment options, 35% of patients underwent POEM, 26% underwent LHM, 9% underwent OHM and 3% underwent Botox injections. There were no major complications reported in either LHM or POEM, with 78% of patients seeing symptom resolution within one to 21 months follow-up.

Conclusions

No differences in post-operative complications were reported in the literature for LHM or POEM.