Dilated esophagus and achalasia after lap band surgery

Question Below Submitted By:  

Julie (a patient from Washington State)

Dilated esophagus with retained column of barium and “bird’s beaking” suggestive of achalasia

Dilated esophagus with retained column of barium and “bird’s beaking” suggestive of achalasia

I was recently hospitalized for aspiration pneumonia. They thought it was related to the lap band, so they took it out. The GI doctor did and EGD and said I have a dilated esophagus and achalasia, and I am seeing him Monday to follow up.

I am wondering what to expect. Will this go away now that the band is out?

The docs said the band placement was fine and I had no fill for years. I believe the problem was not the result of a too tight band, rather a reaction to the band itself since the esophageal spasms started within the few months of band placement, before I had a fill. At the time I thought it was just normal and just the way it felt to have a band.


Expert Responses to the Question Above

Bariatric surgeon at CBGSA , Arcadia , California

by: Dr. Troy LaMar

Hi Julie,

Not a whole lot to add to Lap Band Groupie's note. Would only add that in addition to the LES not working correctly in achalasia, the esophagus muscle does not work correctly either, ie. it does not move food down the esophagus correctly or at all.

Esophageal dilatation after lap banding is a known complication, and is not uncommon.

The question is does it become symptomatic.

In your case it has, and removal of the band is warranted. Often, the esophagus will rebound, or begin to function better with time... if not, the additional treatments will be available.

I'm glad you are following up with your surgeon. Of note, our group rarely does bands anymore, and this is one of the reasons.

Good luck,
Dr. LaMar

los angeles bariatric surgeon

(click here for Dr. LaMar's full bio & contact info)

DISCLAIMER: This educational advice is based on the depth of your question and the details provided. The above should never replace the advice of your local physicians as they have the ability to evaluate you in person.

Related Pages:
- Lap Band Problems & Lap Band Complications
- Lap Band Surgery Failure - 2 Types & How to Avoid Them
Image source: Idiopathic (primary) achalasia. Orphanet Journal of Rare Diseases 2007


Patient Responses to the Question Above


by: rie

i have a lap band. all fills was removed for a surgery. my esophagus is widen. so they wont refill the band. and i gained 60 % of my weight back. how do i reduce the wideing of my esophagus? so i can lose this weight!ri

Permanent Damage

by: Anonymous

I had a gastric band for 10 years and ended up having it removed because of a dilated esophagus.

Further tests showed the LES muscle was no longer working and I had a Heller Myotomy at Mayo Clinic, where the surgeon said she has seen quite a few people with this damage from the band. I remain with permanent loss of peristalsis. I believe with time the pouch walls became less sensitive and I ate more food to feel that fullness.

Then it started piling up in my esophagus.

I had lost a total of 78 pounds and achieved my goal. I slowly gained 15 pounds back (while the band was still intact) but have maintained that for 5 years. So while the band left me with damage, I am grateful I have a permanent weight loss I would not have achieved otherwise.

I am in a similar position

by: Janette

I too had to have my lapband removed due to reflux causing pneumonia but unfortunately for me I went septic in just a few short hours, no symptoms. It took 2 years and 2 additional pneumonia s before realizing it was the lapband.

They removed the lapband, repair an esophageal hernia and performed a gastric bypass. I was doing great! everything seemed to have resolved and I was getting healthy again. Then BOOM, 2 months ago i got really sick again. 2 weeks ago did a barium x-ray and it showed the reflux was back with a vengeance and that the LES was remaining open. I am currently waiting auth for additional tests. We havent discussed further options yet but the waiting is the hard part because it is possible to get seriously ill again. Pray for me and I will pray for you!

Lap Band follow ups

by: Kristie

HiI am a Lap Band patient of about seven years.

The last five years I have had no follow up visits with my surgeon.

The reason is I had an office visit, were I received my last fill, and there was a lapse in my insurance that I wasn't aware about.

This lack of insurance resulted in a 300.00 plus bill I have been unable to pay. I'm currently on disability, with both Medicare and Medicaid.

The doctor's office refuses care because of this unpaid bill even though Medicare covers my visits.My question is: is this dangerous to go so long without any aftercare visits? I recently have developed some acid reflux problems and am concerned about my esophagus.

Please advise.

I receive $700 from social security. I think you can see why spending half my monthly income to pay one Bill has been a challenge.So is it safe not to be seen after so many years? My understanding at the time of my surgery was that follow up care was a life long thing.Thanks for any advise you can give. Kristie

problems breathing

by: Anonymous

Did you find out? I have been having shortness of breath. My chest feels so heavy. I had my lapband removed and I still having breathing problems.


by: Lap Band Groupie

First, I'm not a Dr., but I'll tell you what I can (sorry this is long, and this first paragraph is more for others who just have aspiration pneumonia, reflux, or a dilated esophagus).

Generally Banders who develop aspiration pneumonia (this can be very serious, so I'm happy you're OK) due so due to two reasons; either they have a too tight Band and the food isn't passing fast enough so they aspirate food or more commonly reflux acid back up the esophagus.

This generally happens at night while they're sleeping and they wake up coughing or choking.

The food or acid caused the infection/pneumonia in the lungs.

Secondly, even if your Band and Stoma are placed and working properly, Banders can overfill their pouch and over time stretch the esophagus and essentially use the lower portion of their esophagus as a second pouch to hold more food.

Over time this can cause the bottom sphincter of their esophagus (purpose of it is to keep food and reflux from coming back up into your esophagus) to not close properly leaving your esophagus open to reflux acid and foods that can again be regurgitated into your lungs.

If caught early on, these can usually be reversed with a complete unfill and after a few months things sometimes return to normal.

Any signs of reflux, choking, or coughing during the night are red flags to get to your Doc.

Now on to you.

I not very familiar with achalsia (rare disease of the esophagus, failure of the esophageal sphincter to relax/pass food), but I know that many LB Docs order an upper GI before Banding to rule out any esophageal/stomach problems like this, before surgery (I haven't hear of any Doc doing a LB procedure after achalsia is diagnosed).

If the sphincter isn't releasing the food into the pouch then it will stay and can get aspirated into the lungs (probably again when you lay down), which sounds like what happened to you.

Since you had no fill, a defill was ruled out and their only option was to remove the Band.

I've never heard of anyone saying this disease was 'caused' by the LB, but maybe your Doc was saying what other Banders have said that the symptoms of achalsia are exasperated by having the LB, when he said you were having 'a reaction to the LB'.

It therefore sounds like you may have had this problem before Banding but didn't know it/were asymptomatic and I'm hopeful for your sake that since you didn't mention having issues before Banding that everything will return to normal and your achalsia will not be an issue.

If not, it doesn't 'go away', but there are other treatments for the achalsia including oral medicines, balloon dilations, surgery, and even Botox to relax the muscle.

I'd also say that I'm surprised this wasn't caught earlier as you mentioned having esophageal spasms (can be very painful and isn't normal) early on and this wasn't diagnosed for years.

I'm sure your Doc will have more detailed answers and I hope you'll recover well.

Let us know how you're doing.

Best Wishes!

choking at night.

by: vicky

I had a lapband fitted in 2011 - I slowly lost the weight and everything was fine. Towards the end of my 2 years aftercare I had the last fill, which caused reflux and heartburn but I thought this was normal. GP refused to help for a long time as the lapband was done privately. I was prescribed Gaviscon which worked for a while then Omeprazole, which I still have to this day.

When the reflux and choking started I went to the GP and they didn't seem too worried about it even though I explained it felt like it was leaking into my lungs. I suffered for months an then had to reduce fluid intake a few hours before bed. I would also have to bring up anything that felt like it was above the band. Had to go to A&E for anyone to listen and then had a referral for a camera down. They didn't find anything at all so again I was left looking like a fool but still suffering every night.

Last year, I finally got pregnant (the reason I had the band was so that I had a better chance of conceiving). During the pregnancy I didn't put weight on but rather lost it and I didn't get much of a bump. The choking at night subsided and I had no problems. I had a beautiful baby girl who is doing really well now after a few problems at first.

When I got home from hospital and settled into being a new mummy the choking at night started up again but this time it was accompanied by severe chest pain which felt a lot like trapped wind. I went to the GP who prescribed something that shouldn't be taken when breast feeding so I couldn't take those. After 5 weeks of struggling to eat and drink due to the trapped wind I had to switch the baby to formula as I literally had no energy at all. My weight at the 8 week pregnancy check was 81kg, I went down to 77kg during the pregnancy and I've just had my post natal checks and am currently at 66kg. My family and friends are worried about me but my GP doesn't seem to listen. I would love any advice that might help! Thanks in advance.

Stretched Esophagus

by: Linda McIntyre

I'm writing this in the hope someone can shed some light on the subject.

I've had a band for 15 years and lost 12 stones but 2 years ago a piece of tubing went a miss so I had no restriction and started gaining weight. I had a repair done 10 months ago but have lost only 1.5 stone.

I was told on Friday that I may have a stretched esophagus. I don't have reflux and no sickness, just not losing weight.

Any suggestions?

Lap Band done in Mexico

by: Jennifer Green

I don't wish to advise anyone to go to Mexico, for a less expensive surgery. They do not tell you that it is difficult to ascertain medical care or fills when returning to the United States.

I have had major issues and recently returned back to Mexico because my band became twisted and knotted with a spout that isn't reachable. Cannot say I have really lost any weight. I am a truly dissatisfied customer. A big waste of money.

10 years with lap band

by: Julie

Hi it's been 10 years I've had my lapband. I've always had chocking issues. Sometimes worse than others, but for the last 2 days it feels like even a sip of water is staying in my throat. To even eat a few table spoons of anything is taking me hours. What might be going on??

Ball is developing where lap-band was removed

by: Nancy

The lap-band was removed and the sleeve procedure was performed seven months ago (both done at the same time). I realized today that a ball is developing on the area where the port used to be. It looks like a deformed small ball is under my skin. Does anyone have any insight on this?

lap band slipped and everything gets stuck.

by: shelly

I got my lap band 8 years ago. Everything was going great until I was diagnosed with cancer and had to undergo chemo. I believe all the vomiting from chemo caused my lap band to slip and is now around my esophagus. Everything is now getting stuck from food to liquid and it is very painful.

My question is, if I have the band removed will it solve the problem of everything getting stuck and allow me to eat again or is this going to be forever? I have gone beyond the amount of weight I wanted to lose because I cant eat and not sure how long ensures will keep me going.

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