INTRODUCTION: Intragastric band migration is one of the possible long-term complications of laparoscopic adjustable gastric banding that classically requires surgical treatment. Previous attempts at endoscopic removal of eroded bands have included the use of laser ablation, electrosurgical devices, and Endoscopic scissors. We report a case of endoscopic removal of partially eroded gastric band with items commonly used in the endoscopic suite.
METHODS:A 64 year old female 5 years status post laparoscopic adjustable gastric band placement presented with weight gain, lack of restriction, and a chronic draining abdominal sinus tract. On exam the patient is a morbidly obese female weighing 326 lbs with a BMI of 46. She has a large, ventral hernia extending from the xiphoid to the umbilicus. The band port is located subxiphoid with a draining wound in the epigastrum 10 cm inferiomedial. Esophagogastroduodenoscopy shows a partially eroded, gastric band at the anterior wall of the stomach immediately distal to the gastroesophageal junction. PROCEDURE: A flexible gastroscope is used with carbon dioxide insufflation, a biliary lithotriptor, a flexible straight tip wire, (0.035 in x 450cm) and an endoscopic snare, (7fr x 240cm) to retrieve the eroded band. The scope is passed into the stomach and retroflexed. A flexible straight tip wire is introduced via the endoscope. The wire is passed through the inner circumference of the band. The scope is withdrawn to pull one end of the wire completely through the scope extending out of the mouth. The scope is reintroduced with a snare. The other intragastric end of the wire is snared and brought out on the other side of the band to encircle the band. Both wires are passed out of the mouth. A lithotripsy basket is removed from the lithotriptor channel to shorten the shaft and the ends of the wires pulled up through the shaft. The hand held portion of the lithotriptor is reattached and the lithotriptor shaft advanced down to the band. The lithotriptor is progressively ratcheted down and the wire cuts through the band. The gastroscope is reintroduced, and a standard polypectomy snare is used to grab one side of the band. The band is pulled into the stomach with some manipulation and a fair amount of tension. During this portion the band becomes unbuckled into two pieces. The second part of the band on the other side is snared and withdrawn. An upper gastrointestinal series on post operative day 1 shows no leak. The patient was discharged on full liquids and a proton pump inhibitor.
CONCLUSION: Endoscopic removal with standard endoscopic instrumentation is an option for treatment of an eroded gastric band.
Session: Video Channel
Program Number: V077