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CC BY 4.0 · Journal of Digestive Endoscopy 2025; 16(03): 165-168
DOI: 10.1055/s-0045-1810092
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Post-Laparoscopic Sleeve Gastroplasty (LSG) Achalasia Cardia: A Rare Duo Managed by Peroral Endoscopic Myotomy (POEM)

Authors

  • Kapil Sharma

    1   Department of Gastroenterology, Sarvodaya Hospital and MRC, Faridabad, Haryana, India

  • Bilal Ahmed Wani

    2   Department of Gastroenterology, Hamadard Institute of Medical Science, New Delhi, India

  • Faisal Rasheed

    3   Department of Gastroenterology, NEO Hospital, Noida, Uttar Pradesh, India

  • Wahid Akbar

    4   Department of Gastroenterology, Amandeep Hospital, Shrinagar, Kashmir, India

  • Mamta Sharma

    5   Department of Preventive and Social Medicine, Al-Falah Medical College, Faridabad, Haryana, India

Funding None.
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Dysphagia following bariatric surgery is increasingly recognized, often due to post-obesity surgery esophageal dysfunction (POSED) or true achalasia cardia (AC). Peroral endoscopic myotomy (POEM) after laparoscopic sleeve gastroplasty (LSG) is rare, with only seven cases reported to date. We present the 8th case.

A 23-year-old male with morbid obesity (body mass index 38.2 kg/m2) underwent LSG in 2019, achieving approximately 20 kg weight loss. He later developed progressive dysphagia to solids and liquids over 1.5 years (Eckardt score: 8). Upper gastrointestinal endoscopy revealed a dilated esophagus with liquid residue and a tight lower esophageal sphincter (LES). High-resolution manometry confirmed type II AC with panesophageal pressurization (PEP) ([Fig. 1]), and barium swallow showed complete contrast retention ([Fig. 2]). Computed Tomography shows a dilated and fluid filled oesophagus with remnant gastric sleeve following Laparoscopic sleeve gastrectomy ([Fig. 3]). The patient underwent successful POEM ([Video 1]). Follow-up imaging at 24 hours showed smooth barium passage across the gastroesophageal junction ([Fig. 4]); manometry demonstrated loss of PEP and integrated relaxation pressure reduction to 4.3 ([Fig. 5]).



Publication History

Article published online:
28 July 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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