Endoscopic management of gastric band erosions: a 7-year series of 14 patients

Abstract

Background: Intragastric band migration is an unusual but major complication of gastric banding. We review our experience with endoscopic removal of eroded gastric bands. Methods:We retrospectively evaluated the cases of 110 morbidly obese patients who underwent adjustable gastric banding between 2005 and 2012 to identify those who experienced band erosion. To remove the migrated band, we used an endoscopic approach with a Gastric Band Cutter.Results: Band or tube erosion occurred in 14 patients (12.7%). The median time interval from the initial gastric band placement to the diagnosis of band erosion was 32 (range 18-52) months. Upper abdominal pain, port site infection, loss of restriction and weight regain were the most common symptoms. We used the Gastric Band Cutter to remove the band endoscopically. It was able to cut the band successfully in all but 1 patient, in whom twisting of the cutting wire required conversion from endoscopy to laparotomy. In 2 patients, the band, after being cut, was locked in the gastric wall and required laparotomic removal. In 1 patient, we performed surgery for intragastric pene tration of the connecting tube broken close to the band. Conclusion:The Gastric Band Cutter was successful in dividing the band in all but 1 patient, although we could not always complete the procedure endoscopically. Endoscopic removal seems to be effective and safe for band erosion.Contexte : La migration intragastrique de l'anneau est une complication rare, mais majeure du cerclage gastrique. Nous faisons le point sur notre expérience du retrait endoscopique des anneaux gastriques érodés.Méthodes : Nous avons évalué de manière rétrospective le cas de 110 patients atteints d'obésité morbide qui ont subi un cerclage gastrique ajustable entre 2005 et 2012 afin de vérifier si les anneaux en place étaient érodés. Pour retirer les anneaux qui avaient migré, nous avons utilisé l'approche endoscopique et un dispositif pour sectionner l'anneau gastrique.Résultats : L'anneau ou le tube s'est érodé chez 14 patients (12,7 %). L'intervalle médian entre la pose initiale de l'anneau gastrique et le diagnostic d'érosion a été de 32 (entre 18 et 52) mois. La douleur abdominale haute, l'infection du port d'accès, la diminution de la restriction et la reprise de poids ont été les symptômes les plus fréquents. Nous avons utilisé un dispositif pour sectionner l'anneau gastrique afin de retirer l'anneau par voie endoscopique. Le dispositif a permis de sectionner l'anneau avec succès chez tous les patients sauf 1; dans ce dernier cas, une torsion du fil à sectionner a nécessité la conversion de l'endoscopie en une laparotomie. Chez 2 patients, une fois sectionné, l'anneau est resté emprisonné dans la paroi gastrique et a nécessité une extraction laparotomique. Chez 1 patient, nous avons effectué une intervention chirurgicale en raison de la pénétration intragastrique de la tubulure de raccord sectionnée à proximité de l'anneau. Conclusion :Le dispositif servant à sectionner l'anneau gastrique a bien fonctionné chez tous les...

Safety and effectiveness of laparoscopic management in 210 patients with erosion of adjustable Gastric banding

“…The gastroscopy showed us the state of the esophageal mucosa, the perfect location of the band, the percentage of intra-gastric migration and the lesions of the gastric mucosa. The experts report endoscopic removal of the LAGB, but that requires the buckles of the band to be eroded and special endoscopic instruments; also, the endoscopist has to be experienced [13][14][15]. In our group of patients, we attempted to remove the band in three patients with the endoscope, but removal was not possible.…”

Laparoscopic adjustable gastric banding migration: an early approach for a late complication

“…Even if different approaches are shown in literature, endoscopic procedure in the post-bariatric follow-up is a valid possibility to diagnose and treat complications (1,3,9,12,13).…”

“…The banding migration into the stomach lumen could be easily individuated and, in selected cases, treated by an upper endoscopy (1,3).…”

Endoscopic Treatment of Diverse Complications Caused by Laparoscopic Adjustable Gastric Banding: A Study in Eastern Asia

“…The usual treatment for these complications is laparoscopic or open surgery, while endoscopy is rarely used for treatment, but rather diagnostic purposes. Nevertheless, the potential for endoscopic therapy has gradually expanded, especially in cases of band migration 1,5,6,12,13. Because of their minimal invasiveness, safety, and cost-effectiveness, endoscopic procedures are considered a more attractive alternative.…”