Endoscopic Reversal and Bypass of Strictured Vertical Banded Gastroplasty

Nathan E Conway, MD, Ashwin A Kurian, MD, Christy M Dunst, MD, Lee L Swanstrom, MD, Kevin M Reavis, MD

The Oregon Clinic and Providence Cancer Center, Portland, OR

Background: Vertical banded gastroplasty (VBG) is a restrictive bariatric procedure performed by placing a prosthetic band through a stapled window in the stomach around the lesser curve creating a small proximal gastric pouch. Popular in the 1980’s, this procedure can result in a fixed outlet obstruction over time which has traditionally been addressed with surgical reconstruction. More recently, endoscopic removal of eroded gastric bands and division of the bands has been demonstrated.

Methods: We present two patients with previous VBGs who presented with persistent nausea and vomiting. Both underwent preoperative workup demonstrating partial gastric pouch outlet obstruction. Endoscopic gastric band division was planned. For the first patient, needle knife and sphincterotome cautery divided the band and stricture. The band in the second patient was refractory to this approach, thus a dual endoscopic guided gastro-gastrostomy was fashioned using needle knife cautery and balloon dilation with temporary stent reinforcement to bypass the obstruction.

Results: Postoperative swallow studies revealed restoration of gastric flow. The patients tolerated resumption of diet and are doing well 6 weeks following the procedures.

Conclusions: Endoscopic reversal of VBG is feasible and safe. Alternative action plans are necessary for cases refractory to the initially planned treatment.

Session: Podium Presentation

Program Number: V032

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