Post written by Mark Hanscom, MD, from Weill Cornell Medicine, New York, New York, USA.

With this video case, we present the endoscopic removal of 2 types of eroded gastric bands.

In the first case, a patient presented following adjustable laparoscopic gastric band (Lap-Band) placement with weight regain. Initial testing with an upper GI series identified a 75% eroded band into the stomach lumen. A multidisciplinary approach was pursued because of the presence of an attached, subcutaneous access port included with the Lap-Band that required surgical removal.

First, the connection tubing was cut, and the subcutaneous access port was removed surgically. Then, endoscopic scissors (Ensizor; Apollo Endoscopy, Tex, USA) were used to sever the intralumenal portion of the gastric band, and the band was removed transorally using a rat-tooth forceps (Micro-Tech Endoscopy, Ann Arbor, Mich, USA). The gastrostomy defect was not closed because the band itself is usually encapsulated in fibrous scar tissue, preventing free perforation.

In the second case, a patient presented following vertical banded gastroplasty (VBG) with nausea and vomiting. Endoscopic evaluation revealed a 75% eroded gastric band, which was severed using endoscopic scissors and removed transorally. In addition, a large remnant tissue bridge was resected using an endoscopic knife (SB knife; Olympus Corp, Center Valley, Pa, USA), which was contributing to the patient’s obstructive symptoms.  

Lap-Band and VBG were common types of bariatric surgery. Although both surgeries have fallen out of favor, gastroenterologists still encounter patients with adverse events from these procedures, as they were popular in the 1990s and 2000s. Both procedures involve placement of a restrictive band to create a small stomach pouch.

However, with Lap-Band, the gastric band is much thicker in width and diameter, making it more difficult to sever. Lap-Band also includes an attached subcutaneous port that must be removed surgically. Adverse events of both procedures include band erosion, which can lead to symptoms that necessitate endoscopic or surgical revision.

Endoscopic removal of eroded gastric bands is safe and effective. It is important for gastroenterologists to distinguish between a Lap-Band and VBG, as the management approach differs because of attached connection tubing to a subcutaneous port in the former.

As a result, Lap-Band removal requires a combined surgical and endoscopic approach. Compared with alternative techniques of endoscopic removal, such as use of a guidewire wound by a mechanical lithotripter, the endoscopic scissor-assisted technique is less technically complex and does not require expertise in using a mechanical lithotripter.

Illustrated comparison of an adjustable laparoscopic gastric band (Lap-Band; left) versus vertical banded gastroplasty (VBG; right). The Lap-Band consists of a thick silicone elastomer. In comparison, the gastric band in a VBG is much slimmer and easier to sever.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.