BACKGROUND

Obesity is an epidemic on the rise. Nowadays, Sleeve gastrectomy and Gastric Bypass are the most often- performed bariatric surgeries, creating a potential high-pressure zone just distal to the esophagus. Limited data exist regarding esophageal motility disorders after these procedures.

OBJECTIVE

The aim of this study is to present a systematic review of the literature, in order to highlight the incidence of such a rare complication, and thus its role to differentialdiagnosis algorithm and targeted treatment.

DATA SOURCES

A literature review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines performed in December 2017 revealed 40 articles of interest. Search terms included achalasia or pseudoachalasia after sleeve gastrectomy, or after gastric bypass.

STUDY SELECTION

We included only studies in English or German language and published material with available data in print or on the web in full text. The time of publication was not considered as a restriction for our study.

MAIN OUTCOME MEASURES

The articles described cases diagnosed with postoperative achalasia or pseudoachalasia after Sleeve Gastrectomy or Gastric Bypass, treated with Laparoscopic or Robotic Heller Myotomy (LHM or RHM), or Peroral Endoscopic Myotomy (POEM), and/ or Gastric Bypass revision, and/ or conversion to RYGB through laparoscopic or open procedure were evaluated.

RESULTS

We identified 395 publications. After duplicates and irrelevant articles have been excluded, 40 publications remained for full-text evaluation. Finally, 12 articles were included in this systematic review, revealing 22 cases.

CONCLUSIONS

Data on esophageal motility disorders after bariatric surgery have been limited in the literature to date. However, our results reveal an increasing tendency of case reports, related to postoperative achalasia, especially after RYGB. Moreover, our results suggest that achalasia can be effectively treated with surgical interventions. Heller Myotomy is still the procedure of choice, while POEM seems to be safe and effective, as well. Raising awareness that achalasia can occur after bariatric surgery is essential for the differentialdiagnosis and targeted treatment of these patients.