Pseudo-achalasia: a complication of laparoscopic adjustable gastric banding

Abstract

A 49-year-old woman presented with dyspepsia and nocturnal regurgitation. A laparoscopic adjustable gastric binding (LAGB) had been performed 6 years before presentation. An upper gastrointestinal barium contrast study was performed and revealed a marked dilatation and tortuous course of the esophagus as well as absence of peristalsis and delayed evacuation of the esophagus (Fig. A, B). The findings were compatible with an achalasia-like disorder. An esophageal manometry revealed a constant high LES pressure with aperistalsis, thus confirming the diagnosis of (pseudo-)achalasia. Consequently a complete band deflation was conducted and resulted in a complete resolution of the patient’s symptoms. Two weeks later the control contrast study showed a marked improvement of the delayed evacuation and a small regain of peristaltic function. The dilatation and “sigmoidlike” image of the esophagus remained unchanged (Fig. C).