Background

A 53-year-old male with a history of laparoscopic adjustable gastric banding (LAGB) 15 years ago presented to the clinic due to persistent dysphagia for two years despite the deflation of the band. On investigation, an upper gastrointestinal series demonstrated dilated tortuous sigmoid esophagus measuring 6.6cm in diameter (Fig. 1A). Esophagogastroduodenoscopy revealed inflamed mucosa, a tortuous esophagus, and a high lower esophagus sphincter pressure. A biopsy of the distal esophagus did not show any evidence of malignancy. Those findings were consistent with a diagnosis of pseudoachalasia secondary to LAGB, resulting in a sigmoid esophagus. The patient underwent gastric band removal with rapid resolution of symptoms. Postoperative barium study showed improvement of dilatation (Fig.1B). At three months postoperative follow-up, high-resolution manometry demonstrated normal motility. Pseudoachalasia is a known complication following a gastric band placement, which is reversible with band removal. However, subsequent development of sigmoid esophagus is uncommon. In patients with achalasia, sigmoid esophagus is considered a late-stage of achalasia and associated with worse outcomes with myotomy compared to earlier-stage achalasia. Sigmoid esophagus may require esophagectomy. Although there are case reports of mega esophagus resolving after band removal, from our literature search this is the first case that we know of that has shown resolution of sigmoid esophagus and showed normalization of esophageal motility after band removal in such a severe pseudoachalasia case.