Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, 8 Place de l'Abbé G. Hénocque 75013 Ramsay Santé, Paris, France.
Service de Chirurgie Digestive, Clinique Geoffroy Saint Hilaire, Ramsay Santé, Paris, France.
Obes Surg. 2021 Jun;31(6):2843-2844. doi: 10.1007/s11695-021-05370-5. Epub 2021 Apr 15.
Achalasia after bariatric surgery is a rare pathological entity. Nonetheless, several cases have been described in literature. Per oral endoscopic myotomy has recently emerged as the preferred approach for the management of esophageal motility disorders.
We report a video case of POEM performed in a female patient with prior multiple bariatric surgical procedures. In her past medical history, she underwent to laparoscopic lap band, sleeve gastrectomy, and Roux-Y-gastric bypass.
POEM was carried out without complication. Myotomy was performed only for 1 cm below the cardias due to the presence of the gastro-jejunal anastomosis. Post-operative course was uneventful and oral diet was restarted after one day. At 2 months follow-up, the patient is asymptomatic with no weight regain.
We report the first case of POEM after three different bariatric surgical procedure. Fibrosis due to prior interventions did not hampered POEM procedure, and the shorter myotomy due to the presence of small gastric pouch did not reduced its efficacy.
肥胖症手术后发生贲门失弛缓症是一种罕见的病理实体。尽管如此，文献中仍有几例描述。经口内镜肌切开术（POEM）最近已成为治疗食管动力障碍的首选方法。
我们报告了一例女性患者在先前进行多次减重手术后接受 POEM 的视频病例。在她的既往病史中，她接受了腹腔镜胃带、袖状胃切除术和 Roux-Y 胃旁路术。
POEM 手术无并发症。由于存在胃空肠吻合口，仅在贲门下方 1 厘米处进行肌切开术。术后过程顺利，术后第一天开始恢复口服饮食。在 2 个月的随访中，患者无症状，无体重反弹。
我们报告了首例三次不同减重手术后接受 POEM 的病例。先前干预引起的纤维化并未妨碍 POEM 手术的进行，由于小胃囊的存在导致的较短肌切开术并未降低其疗效。
