Application of Peroral Endoscopic Myotomy (POEM) in the Treatment of Achalasia in Post-Bariatric Patients: Case Reports and Analysis of Efficacy and Safety.

Author(s): Vanessa Costa Muniz, Willian Chaves, Adriano Silvério da Paixão, Ana Caroline C. da Silva, Daniel Salerno Muzilli, Bárbara Esteves Silva, Laís Yumi Takaoka, Lara Godela Delatore, Tauane de Lima Fiorillo

This paper discusses the application of Peroral Endoscopic Myotomy (POEM) in the treatment of achalasia in post-bariatric patients. Achalasia is an esophageal motility disorder characterized by malfunction of the lower esophageal sphincter (LES) and esophageal aperistalsis. POEM has emerged as a promising and less invasive technique for the treatment of this condition, particularly in patients with previous bariatric surgery. We present two cases of post-bariatric patients with achalasia successfully treated through POEM. The first case involved a 52-year-old man who had undergone Roux-en-Y Gastric Bypass (RYGB) 10 years ago, presenting symptoms of progressive dysphagia. The second case involved a 24-year-old woman who underwent a Roux-en-Y gastric bypass (RYGB) in 2015, with intense dysphagia. Both patients underwent POEM, resulting in significant improvement of symptoms. We discuss the efficacy of POEM in the treatment of achalasia in post-bariatric patients. Previous studies have reported positive short-term results with POEM in patients with previous RYGB, indicating that the technique is feasible and safe in this patient group. POEM offers a less invasive approach, avoiding the need for open surgical access, which can be challenging in post-bariatric patients due to scarring, adhesions, and anatomical distortions.

Peroral Endoscopic Myotomy (POEM), Achalasia, Bariatric Surgery, Dysphagia, Lower Esophageal Sphincter, Esophageal Motility Disorders

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