Gastric Lap Band as a Cause of Pseudoachalasia

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Abstract

Introduction: Achalasia is a rare esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter and loss of esophageal peristalsis. Pseudoachalasia, often caused by malignancy or mechanical obstruction, mimics the clinical presentation of achalasia. [1] This case report highlights an unusual presentation of pseudoachalasia caused by a gastric lap band. Case Description/Methods: We present the case of an 80-year-old woman with a surgical history of laparoscopic gastric banding for obesity who was diagnosed with achalasia in 2013. Management was initially conservative following a comprehensive diagnostic workup including EGD, VFSS, esophageal manometry, and a barium study. The patient did not wish to undergo myotomy. She was lost to follow up for over 10 years and re-presented due to progressive solid and liquid dysphagia with accompanied regurgitation. After further chart review, it was found that her laparoscopic gastric band had not been assessed for 2 decades. Taking into account her surgical history, pseudoachalasia due to lap band migration or hyperinflation was considered. A repeat barium swallow study demonstrated delayed passage of contrast through a narrow lumen at the level of the gastric band suggestive of obstruction. The patient was then referred to bariatric surgery for deflation of the gastric lap band. Discussion: Pseudoachalasia is a condition that mimics the clinical features of primary achalasia. It can be caused by a variety of etiologies including malignancy, particularly those involving the gastroesophageal junction, as well as anatomical abnormalities or previous surgical interventions. Identifying pseudoachalasia is imperative for effective treatment initiation. While primary achalasia may be managed with interventions such as Heller myotomy or POEM, pseudoachalasia requires addressing the underlying cause. For our patient, this meant deflation of the gastric lap band. Routine achalasia work-up sometimes fails to distinguish between pseudo and primary achalasia, thus a high clinical suspicion and proper history is paramount in initiating diagnostic work-up. This case highlights the importance of considering pseudoachalasia in patients with a history of gastric surgeries due to their altered anatomy.

Volume

119

Issue

10

First Page

S2259

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