# Resolution of Sigmoid Esophagus After Laparoscopic Adjustable Gastric Band Removal

## TL;DR

A patient's severe esophageal condition improved after removing a gastric band, showing that late-stage pseudoachalasia can be reversed.

## Contribution

This case demonstrates successful treatment of late-stage pseudoachalasia with a sigmoid esophagus through gastric band removal.

## Key findings

- Band removal led to rapid symptom resolution and improved esophageal dilatation.
- Three months post-surgery, normal esophageal motility was confirmed via manometry.
- Sigmoid esophagus caused by a gastric band can resolve after band removal.

## Abstract

Pseudoachalasia is a known complication following a gastric band placement that is reversible with band removal. However, the development of a sigmoid esophagus is uncommon. Sigmoid esophagus is considered late-stage achalasia and is associated with worse outcomes with myotomy compared to earlier-stage achalasia. A 53-year-old male with a laparoscopic adjustable gastric band (LAGB) placed 15 years ago presented to the clinic with persistent dysphagia after the band was deflated for symptoms of dysphagia. The upper gastrointestinal series showed a 6.6-cm-diameter, tortuous, sigmoid-shaped esophagus. Esophagogastroduodenoscopy confirmed a diagnosis of sigmoid esophagus proven via the presence of inflamed mucosa, tortuous esophagus, and high lower esophagus sphincter pressure consistent with pseudoachalasia, all secondary to LAGB. The patient then underwent band removal, resulting in rapid resolution of his symptoms. The postoperative barium study showed improvement in dilatation. At the three-month postoperative follow-up, manometry demonstrated normal motility, indicating resolution of the pseudoachalasia and sigmoid esophagus. This case demonstrated band removal as an effective treatment option despite late-stage pseudoachalasia with a sigmoid esophagus.