Severe esophageal dilation causing central airway obstruction: a rare complication of LAGB

Freund, Michael R.; Spira, Ram M.; Reissman, Petachia

doi:10.1016/j.soard.2016.12.007

Cited by 3 publications

(5 citation statements)

References 12 publications

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“…Band removal is recommended once megaoesophagus is diagnosed to prevent any irreversible motility disorders of the oesophagus. 7,9 It is possible that the occasional mid-neck swelling in our patient that was described as a pouch could be a result of longstanding band overinflation and/or overeating. 10 Two published cases have reported acute airway compromise secondary to megaoesophagus related to LAGBs.…”

Section: Discussionmentioning

confidence: 94%

“…The second case was a 43-year-old female who presented to the emergency department with respiratory distress and inspiratory stridor. 7 The megaoesophagus was evident in both chest X-ray and CT scan, and the symptoms resolved with band deflation. In our case, although the pre-existing LAGB was known and the oesophagus was dilated up to 75 mm (CT scan finding), the chest X-ray was inconclusive of megaoesophagus.…”

Section: Discussionmentioning

confidence: 97%

“…5,6 Oesophageal dilatation is further attributed to a combination of overeating, an overinflated band, an underlying motility disorder, and psychological factors. 7 On rare occasions, aperistalsis and severe dilatation can lead to megaoesophagus or pseudoachalasia, characterised by either a 100% increase from baseline diameter or an enlargement >50 mm in diameter. 5,8 This mimics major achalasia cardia-like dilatation, and warrants band removal.…”

Section: Discussionmentioning

confidence: 99%

“…10 Two published cases have reported acute airway compromise secondary to megaoesophagus related to LAGBs. 7,11 The first report described acute respiratory distress within 24 hours of an abdominoplasty in a 39year-old female patient. 11 A CT scan was performed to rule out pulmonary embolism, and it revealed severe oesophageal dilatation up to 47 mm in diameter.…”

Section: Discussionmentioning

confidence: 99%

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Airway emergency from megaoesophagus: A rare complication of an adjustable gastric band

Lea

Tran

Trochsler

et al. 2022

Anaesth Intensive Care

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A 77-year-old lady with a laparoscopic adjustable gastric band (LAGB), implanted 12 years earlier for obesity, developed an unusual but almost fatal complication, characterised by dysphonia and stridor within minutes and a tensely swollen anterior neck. The condition mimicked haemorrhage into the subcutaneous tissues of the neck, and the airway was secured with an awake fibreoptic intubation. Subsequent computed tomography imaging of the abdomen and chest revealed megaoesophagus with dilatation up to 7 cm, proximal to the gastric band. The band was then deflated percutaneously with immediate resolution of the neck swelling. In patients with LAGB in situ, fluid should be removed from the band for any suspected device-associated symptoms such as severe vomiting, severe gastro-oesophageal reflux or neck swelling and respiratory distress. When there is radiological evidence of gross oesophageal dilatation or a high likelihood of an obstructive pathology at the level of the band, a careful nasogastric tube decompression may also resolve reflux, neck swelling or respiratory distress. A complication associated with LAGB should be considered in a patient with unexplained neck swelling or other features of airway obstruction who has an LAGB in situ.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Airway emergency from megaoesophagus: A rare complication of an adjustable gastric band

Lea

Tran

Trochsler

et al. 2022

Anaesth Intensive Care

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“…Second, although the rate of stricture occurrence in cervical esophageal cancer patients was markedly higher than in other locations, the number of patients in this study was not sufficient to demonstrate a statistically significance. However when dilation of the cervical esophagus is required to treat stricture there is a risk of airway obstruction [ 34 ], and thus prevention of stricture in the cervical esophageal cancer has a high priority from a clinical standpoint. Third, because the remaining mucosa contracts after resection, evaluation of resection circumference is subjective.…”

Section: Discussionmentioning

confidence: 99%

Repeated steroid injection and polyglycolic acid shielding for prevention of refractory esophageal stricture

et al. 2023

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Background Postoperative stricture and refractory stricture are severe adverse events which occur after expansive esophageal endoscopic submucosal dissection (ESD). The aim of this study was to assess the efficacy of steroid injection, polyglycolic acid (PGA) shielding, and of additional steroid injection thereafter for the prevention of refractory esophageal stricture. Methods This is a retrospective cohort study of 816 consecutive cases of esophageal ESD performed between 2002 and 2021 at the University of Tokyo Hospital. After 2013, all patients with a diagnosis of superficial esophageal carcinoma covering over 1/2 the esophageal circumference underwent preventive treatment immediately after ESD with either “PGA shielding”, “steroid injection”, or “steroid injection + PGA shielding”. Additional steroid injection was performed for high-risk patients after 2019. Results The risk of refractory stricture was especially high in the cervical esophagus (OR 24.77, p = 0.002) and after total circumferential resection (OR 894.04, p < 0.001). “Steroid injection + PGA shielding” was the only method significantly effective in preventing stricture occurrence (OR 0.36; 95% CI 0.15–0.83, p = 0.012). This method also decreased the risk of refractory stricture (OR 0.38; 95% CI 0.10–1.28, p = 0.096), but additional steroid injection was the only significantly effective method for prevention of refractory stricture (OR 0.42; 95% CI 0.14–0.98, p = 0.029). Conclusion Combining steroid injection and PGA shielding is effective for preventing post-ESD stricture and refractory stricture. Additional steroid injection is a viable option for patients at high-risk for refractory stricture. Graphical abstract

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Steroid injection and polyglycolic acid shielding to prevent stricture after esophageal endoscopic submucosal dissection: a retrospective comparative analysis (with video)

Sakaguchi

Tsuji

Shinozaki

et al. 2020

Gastrointestinal Endoscopy

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Severe esophageal dilation causing central airway obstruction: a rare complication of LAGB

Cited by 3 publications

References 12 publications

Airway emergency from megaoesophagus: A rare complication of an adjustable gastric band

Airway emergency from megaoesophagus: A rare complication of an adjustable gastric band

Repeated steroid injection and polyglycolic acid shielding for prevention of refractory esophageal stricture

Steroid injection and polyglycolic acid shielding to prevent stricture after esophageal endoscopic submucosal dissection: a retrospective comparative analysis (with video)

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