Elsevier

Gastrointestinal Endoscopy

Volume 64, Issue 5, November 2006, Pages 801-804
Gastrointestinal Endoscopy

New Method
Clinical Endoscopy
Endoscopic removal of eroded bands in vertical banded gastroplasty: a novel use of endoscopic scissors (with video)

https://doi.org/10.1016/j.gie.2006.04.036Get rights and content

Background

Vertical banded gastroplasty (VBG) as a surgical therapy for morbid obesity was first described in 1982. VBG involves partitioning the stomach with a vertical staple line and restricting the outlet pouch with a Gortex band. Complications of VBG include partial and total erosion of the band through the vertical staple line or through the lesser curvature into the gastric pouch. Band erosion occurs after surgery in 1% to 3% of patients, and patients may present with symptoms of obstruction, weight gain, nausea, pain, and bleeding. Unless a band has freely eroded from the stomach wall, allowing spontaneous elimination or simple endoscopic retrieval, surgical removal has been required heretofore. Previous attempts at endoscopic removal of eroded bands have included the use of neodymium-yttrium aluminum garnet laser ablation and other electrosurgical devices. Endoscopic scissors transection to remove an eroded laparoscopic band has been described in Europe but has not been performed in the United States.

Objective

In this series, we describe the endoscopic removal of partially eroded bands embedded in the gastric wall by using flexible endoscopic scissors to sever and subsequently withdraw the bands endoscopically through the mouth.

Conclusions

Eroded gastric bands have been safely removed endoscopically in 2 ambulatory outpatients.

Design

Case series.

Setting

Tertiary-care academic center.

Main Outcome Measurements

Efficacy and safety.

Limitations

Highly selected motivated patient population.

Section snippets

Case 1

With the patient under monitored anesthesia care (MAC) sedation with propofol, an Olympus double-channel endoscope (GIF 2T100; Olympus America, Center Valley, Pa) with 3.2-mm and 3.8-mm instrument channels was introduced by mouth and was advanced into the gastric pouch. Optimal exposure to the gastric band was obtained with the endoscope retroflexed in the antrum (Fig. 1A and B). By using alligator forceps (GF-49L-1; Olympus) in the 3.8-mm channel, the gastric band tag was grasped firmly

Discussion

Endoscopic scissors are an important tool in interventional GI endoscopy. Their use was described in the endoscopic palliation of refractory esophageal strictures7 and EMRs.8 Jess and Fonnest6 reported the first use of endoscopic scissors in the removal of an eroded vascular prosthesis placed during gastric surgery. Their report differs from this series, however, in that an electrosurgical device was required to facilitate the extraction of the eroded band.

A considerable difference in duration

Acknowledgments

The authors thank Adele K. Evans, MD, for providing illustrations.

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