Trans-oral Endoscopic Removal of an Eroded Adjustable Gastric Band

Erosion of a laparoscopic adjustable band is a feared complication occurring in less than 0.5% of placed cases. Once diagnosed, removal is imperative. The options for removal include open, laparoscopic and endoscopic approaches. We present for review a video case presentation of an endoscopic removal of an intragastric erosion of an adjustable gastric band.

Our patient is a 40 year old female with a long-standing history of morbid obesity: Height 5’9” / Weight: 280 lbs / BMI: 41.3. She underwent laparoscopic placement of an adjustable gastric band in Mexico two years previously and was able to lose 89 lbs down to a BMI of 28.3. This represents an excess weight loss of > 66%. She presented to our institution one year postoperatively with erosion of her port through the skin. The port was subsequently removed and the wound healed by secondary intention. Due to patient desire for increased restriction, the access port was replaced 6 months later. 2 months later, she represented with a second port site infection requiring port removal with ligation of the residual tubing. After a frank discussion about her surgical options, the patient opted to retain what residual restriction the unfilled band provided. 4 months later, she presented with epigastric & LUQ pain. Diagnostic EGD revealed intragastric erosion of the band.

We performed a trans-oral endoscopic removal of the eroded adjustable gastric band. We utilized an Olympus dual lumen endoscope, endoscopic graspers and an endoscopic snare to accomplish this task. The band was grasped with the endoscopic graspers and with a combination of pulling and rotation, the buckle of the band was exposed intraluminally. The loop of the snare was passed through the band and was grasped with the endoscopic graspers. With a sawing motion, the buckle of the band was divided. The divided band was then snared and extracted trans-orally.

The patient did extremely well in the peri-operative period. A scheduled upper GI on post-operative day one demonstrated no leak and she was advanced to a liquid diet. She was discharged home on postoperative day two and her LUQ pain has completely resolved.

Trans-oral endoscopic removal of an adjustable gastric band is a safe and effective treatment of gastric band erosion.

Session: Podium Video Presentation

Program Number: V027

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