Christopher J. DiMaio, MD, FASGE from the Icahn School of Medicine at Mount Sinai in New York, New York, USA shares this VideoGIE case “Mechanical lithotriptor-assisted endoscopic removal of an eroded gastric lap band.”
Our case involved a patient who experienced partial erosion of a gastric lap band into the stomach. Initial attempt at removing the band by trying to cut through it with endoscopic scissors was unsuccessful. Thus, an alternative approach was pursued, whereby we threaded a 0.035” ERCP wire through the loop of the eroded lap band and then into the crank handle of an emergency mechanical lithotripter. Increasing tensile force was applied to the wire by turning the crank handle, ultimately allowing the wire to transect the eroded lap band. Once this was accomplished, the lap band itself was able to be removed using a standard snare.
Lap band erosion can create significant symptoms for patients. When this situation is encountered, endoscopic removal of the eroded lap band may be very tempting on first glance. However, this video demonstrates that removal is not that straight forward and may require the use of alternative techniques.
Communication and collaboration with your surgical colleagues is key to allowing for both safe and effective management of complex issues traditionally managed surgically.
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