Endoscopy 2019; 51(04): S67-S68
DOI: 10.1055/s-0039-1681369
ESGE Days 2019 oral presentations
Friday, April 5, 2019 14:30 – 16:30: Video Motility South Hall 1B
Georg Thieme Verlag KG Stuttgart · New York

YEYUNAL PERFORATION WITH ACHALASIA BALLON IN A PATIENT WITH RING SLIPPAGE AND GASTRIC POUCH OUTLET STENOSIS AFTER BANDED GASTRIC BYPASS

A Baptista
1   Hospital de Clinicas Caracas, Say Bernardino, Caracas, Venezuela
,
A Salinas
2   Hospital de Clinicas Caracas, Caracas, Venezuela
,
W García
2   Hospital de Clinicas Caracas, Caracas, Venezuela
,
M Guzman
2   Hospital de Clinicas Caracas, Caracas, Venezuela
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Banded gastric bypass (BGBP) has resulted in superior long-term weight loss compared with non-banded gastric bypass. Nevertheless occasional silastic ring slippage could result in gastric pouch outlet stenosis (GPOS). Conventional management has been ring removal through abdominal laparoscopic surgery. However, peritoneal adherences could make surgery challenging and increase the risk of complications.

Endoscopic dilatation of the slipped ring using achalasia balloon with high success and low morbidity has been described. We present a clinical case of 31-year-old female with previous BGBP in 2012 who experienced vomiting, abdominal pain and weight loss in 2016.

Methods:

Upper gastrointestinal endoscopy (UGE) showed retained food and GPOS. A 35-mm achalasia balloon was used to treat silastic ring slippage. Immediately after balloon deflation, active bleeding of the anastomosis occurred. It was controlled by epinephrine injection and electrocoagulation forceps. At the jejunal side of the anastomosis a wide perforation was seen. A 21-cm-length and 30 mm diameter fully covered self-expanding esophageal metallic stent (SEMS) was inmediatly placed. CT scan showed septated neumoperitoneum and no evidence of liquid collections. The patient referred mild abdominal pain after the procedure. Oral feeding and hospital discharge was decided at 36 hours.

Results:

Clinical evolution was satisfactory. Three weeks later SEMS was removed over a plastic overtube retrieval system to avoid laceration of the previously injured area. Perforation was completely sealed. Contrast swallow confirmed absence of leakage. Furthermore silastic ring migrated to the reservoir lumen as result of SEMS local effect. Forceps removal of the ring was safely accomplished.

Conclusions:

The use of achalasia balloon to treat silastic ring slippage in gastric banded bypass could lead to yeyunal perforation. Immediate placement of the stent is an efficient option to manage the perforation and the ring slippage.