Abstract
Background The outcome of peroral endoscopic myotomy (POEM) in patients with prior Roux-en-Y
gastric bypass (RYGB) is not known and some experts have recommended against its performance
in this patient population because of the risk of postoperative regurgitation. The
aim of this study was to report on the outcomes of POEM in patients with RYGB anatomy.
Methods Patients with RYGB anatomy who underwent POEM for the treatment of achalasia at three
tertiary centers were included. POEM was performed in standard fashion using the anterior
or posterior approach. Clinical response was defined by a decrease in Eckardt score
to ≤ 3. Results of esophageal acid exposure testing/pH-impedance and manometric testing
after POEM were reported when available.
Results A total of 10 achalasia patients with prior RYGB surgery underwent POEM. All procedures
were technically successful with anterior myotomy performed in seven patients. The
mean submucosal tunnel length and myotomy length were 12.9 cm and 11.1 cm, respectively.
The mean procedure time was 72 minutes and mean length of hospital stay was 1.5 days.
Clinical success was achieved in all 10 patients with a significant decrease in Eckardt
score from 6.5 to 1 (P < 0.001). None of the patients experienced post-procedural regurgitation. Post-procedural
pH testing was obtained in six patients and was normal in all of them.
Conclusions This study suggests the feasibility, safety, and efficacy of POEM in patients with
prior RYGB surgery. The risk of gastroesophageal reflux disease in these patients
seems to be minimal after POEM.
