Shashideep Singhal, MD, from the Department of Gastroenterology, Hepatology, and Nutrition at The University of Texas at Houston Medical School in Houston, Texas, USA presents this VideoGIE case, “Endoscopic removal of gastric band by use of a stent-induced erosion technique.”
A 51-year-old woman with vertical band gastroplasty presented with epigastric abdominal pain and emesis. An initial upper GI series showed a dilated proximal pouch suggestive of outlet obstruction, which was later confirmed by upper endoscopy. A fully covered 125-mm × 23-mm self-expanding metal stent was placed across the band to induce erosion. The distal end of the stent was placed 5 cm beyond the gastric band with the proximal end just above the gastroesophageal junction. A repeated endoscopy was performed after 2 weeks. Alligator forceps were used to pull the strings and collapse the stent, followed by removal. Endoscopy showed near complete erosion of the band. Alligator forceps were then used to grasp and remove the band with minimal traction.
Vertical banded gastroplasty involves the placement of a fixed gastric band and staples to create a small pouch. Band-induced outlet obstruction is a common delayed adverse event of fixed gastric bands that is conventionally managed by surgery. Endoscopic removal of a gastric band can avoid potential morbidity associated with surgery.
A 2-step endoscopic stent-induced band erosion and subsequent removal technique is a feasible and safe approach to removal of gastric bands.
In case of incomplete erosion of band on removal of stent at week 2, repeat stenting followed by interval endoscopic removal can be done to facilitate complete erosion of band prior to removal.
Endoscopic ultrasound to determine the location of the band within layers of stomach can further assist in making decision to remove the band using endoscopic technique. Migration of band to submucosal layer is likely cause of development of obstructive symptoms and increases the feasibility of endoscopic removal.
Stenosis of gastric pouch outlet after endoscopic gastric band removal can be seen in some cases which can be managed by endoscopic balloon dilation.
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