• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • 2022 NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • SAGES 2021 Annual Meeting
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2021
      • SAGES 2020
      • SAGES 2019
      • SAGES 2018
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • SAGES Logo Products
    • “Unofficial” Logo Products
  • Log In

Ring removal in delayed gastric emptying after RYGB: a novel approach by endoscopic stenting

Josemberg M Campos, MD, Manoel Galvao Neto, MD, Lyz B Silva, MD, Galeno Magalhaes Neto, MD, Maysa Vasconcelos, Eduardo Pachu, MD, Alvaro Ferraz, MD

Universidade Federal de Pernambuco, Recife, PE, Brazil; Gastro Obeso Center, Sao Paulo, SP, Brazil

Ring dysfunction after roux-en-y gastric bypass (RYGB) causing delayed gastric emptying is classically treated by surgical removal, a procedure with risk of complications and weight regain. In a novel way of using self-expandable stents, intraluminal erosion of the ring is achieved, allowing removal by endoscopy, with no need of surgery. No study has shown clinical applicability of this principle in RYGB banded with silastic ring. We analyze endoscopic removal of non-eroded dysfunctional rings after RYGB using self expandable plastic stents (SEPS).

This is a prospective case series of 24 patients managed with SEPS placement, between 2007 and 2012. Successful ring removal, symptoms improvement, weight control and adverse events were evaluated.

Delayed gastric emptying was defined as inability to ingest meat or vomiting episodes with or without gastric pouch stricture. Mean age was 43.2 years, most were female (n=18), median BMI at treatment was 24.5 Kg/m2. Most common symptom was vomiting (n=23), with daily occurrence in 52.2%. Stricture was present in 62.5% and ring slippage in 8.2%.

SEPS placement was done under general anesthesia and fluoroscopic guidance. A standard gastroscope (Pentax Medical, Montvale, NJ), and a PolyflexTM stent (25x21x150mm) (Boston Scientific, Natick, MA) were used in all cases. When there was severe stricture or ring slippage, a previous endoscopic dilation was done, using a TTS balloon (18 mm).

All patients were discharged after a 2-hour observation period, with liquid diet for one week. PPIs were prescribed from stent placement until one month after removal. Stent removal was done under deep sedation, by anesthesiologist.

SEPS induced complete erosion in 16 patients, allowing simultaneous stent and ring removal. In the remaining patients, the ring was removed two weeks later, after complete erosion. The median time of stenting was 15 days. There was one case of stent migration, which was naturally expelled. Most patients needed endoscopic stricture dilation after stent removal (91,2%), with a mean of 2 sessions. Most common adverse event was vomiting (n=6), treated with symptomatic medications. There was no early stent removal, and no serious complications. After a mean follow-up of 7 months, there was no significant change in BMI, and 75% of patients were able to ingest solid foods. (Table 1)

Endoscopic stents led to ring intraluminal erosion in 100% of subjects, allowing successful removal of dysfunctional rings. The procedure is technically feasible and safe, with a 25% occurrence of mild adverse events (vomiting), and no serious complications. It proved to be a reasonable alternative for ring removal in our casuistic, avoiding surgery, and decreasing possibility of weight regain. More studies with a larger number of subjects are needed to confirm our findings.

Table 1. Follow-up results

Characteristics n (%)
Dilation before stent placement 13 (54.2)
Stent length of stay in days (mean +- SD) 15.0 (+-6.8)
Simultaneous stent + ring removal 16 (66.7)
Post-stent dilation sessions (median and range) 2.0 (1.0-3.75)
Solid food ingestion before stent 0 (0.0)
Solid food ingestion after stent 18 (75.0)
BMI variation after stent (median and range) 0.0 (-1.0 – 2.75)

Session: Poster Presentation

Program Number: ETP065

370

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2013 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Surgery is Safer with Vaccination 1

Addressing Religious Concerns About COVID-19 Vaccine

This may be a difficult subject matter for you and your patient to talk about.  Be assured, all major organized religious groups encourage and recommend the COVID-19 vaccine. Listed below are references and websites you can direct your patient towards to help them make an informed decision with regards to their religious concerns against the […]

SAGES Statement on AAPI Violence

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) stands in solidarity with the Asian American and Pacific Islander (AAPI) community. In the summer of 2020, SAGES released a statement condemning the violence, racism, and hatred toward the Black community in the wake of George Floyd and Breonna Taylor’s murders. It is with great sorrow […]

Free SAGES Webinar: Lessons from COVID on Living and Thriving as Surgeons

SAGES recognizes that the COVID-19 pandemic has had a big impact on surgical practice and in surgeon wellness. SAGES’ Reimagining the Practice of Surgery Taskforce will present “Finding the Opportunities: Lessons from COVID and How We Live and Thrive as Surgeons”  to look at ways in which innovative leadership at various levels may help transform […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
[email protected]
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2022 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2022 Society of American Gastrointestinal and Endoscopic Surgeons