title: Potentially reversible pseudoachalasia after laparoscopic adjustable gastric banding.
abstract: BACKGROUND
  Although esophageal dilation after laparoscopic adjustable gastric banding (LAGB) has been reported, the effect of banding on esophageal peristalsis, including the development of aperistalsis and its potential reversibility, have received only little attention.
  
  
  OBJECTIVE
  Our aim was to report our experience with 6 patients who developed manometric evidence of esophageal aperistalsis after LAGB.
  
  
  METHODS
  We retrospectively reviewed the clinical, manometric, and radiologic data of 6 patients referred between September 2005 and June 2007 to our Center for Esophageal Disease for evaluation of dysphagia or heartburn that developed after LAGB, and in whom manometric studies showed aperistalsis. Patients had the fluid in the band completely removed (N=5) or had the band removed (N=1). Reversibility of esophageal aperistalsis was then assessed. Clinical follow-up was obtained from 2009 to early 2010.
  
  
  RESULTS
  Six patients (all female, age range, 37 to 55 y old) were evaluated because of dysphagia or heartburn after LAGB and had complete aperistalsis on manometry. Five of the 6 patients had manometry after removal of all the fluid from the band (N=4) or after surgical removal of the band (N=1). Two patients had partial return of peristalsis, 1 had normal peristalsis, and 2 others had continued aperistalsis but did show clinical improvement. Another patient had improvement of radiologic esophageal dilation but declined repeat manometry.
  
  
  CONCLUSIONS
  LAGB can cause an achalasia-like esophageal aperistalsis that may be reversible. Gastroenterologists caring for bariatric patients need be aware of this pseudoachalasia, as the treatment of such patients differs from those with primary achalasia.
authors.affiliation: Department of Medicine, Center for Esophageal Disease, Weight Management Program, New York University School of Medicine, New York, NY, USA.
authors.forename: Abraham
authors.initials: A
authors.lastname: Khan
authors.forename: Christine
authors.initials: C
authors.lastname: Ren-Fielding
authors.forename: Morris
authors.initials: M
authors.lastname: Traube
mesh_terms: D000328:Adult; D003680:Deglutition Disorders / Q000209:etiology; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D015154:Esophageal Motility Disorders / Q000209:etiology* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods; D006356:Heartburn / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008365:Manometry; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010528:Peristalsis; D012189:Retrospective Studies