Endoscopy 2019; 51(04): S200-S201
DOI: 10.1055/s-0039-1681765
ESGE Days 2019 ePosters
Friday, April 5, 2019 09:00 – 17:00: Clinical Endoscopic Practice ePosters
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC REMOVAL OF A MIGRATED ENDOSCOPIC DUODENOJEJUNAL BYPASS (ENDOBARRIER) WHICH HAD EMBEDDED ITS BARBWIRES INTO THE ANGLE OF TREITZ

A Martinez-Alcala
1   Gastroenterologie, Frankenwald Klinik, Kronach, Germany
,
PT Kroener
2   Mayo Clinic, Jacksonville, United States
,
MA D'Assuncao
1   Gastroenterologie, Frankenwald Klinik, Kronach, Germany
,
S Peter
3   Gastroenterology, Basil Hirschowitz Endoscopic Center of Excellence, Birmingham, United States
,
K Mönkemüller
1   Gastroenterologie, Frankenwald Klinik, Kronach, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

A 56-year-old patient with obesity (BMI 55) underwent placement of a duodenojejunal bypass (Endobarrier). Nine months after the procedure he presented complaining of severe abdominal pain and hematemesis.

Methods:

A nasogastric tube was placed. A CT scan of the abdomen showed acute pancreatitis and migration and incarceration of the Endobarrier to the distal duodenum (Figure, Video). After the patient was stabilized, including transfusion of one unit of blood, endoscopy was performed under general anesthesia.

Results:

The stomach was filled coffee ground material and food rests. Reaching the migrated Endobarrier was impossible with a gastroscope. Thus a colonoscope was used. The metallic barbs were seen but they were anchored against the mucosa, causing lacerations and bleeding. Therefore, the scope was removed and a “colon” overtube (US Endoscopy) with a pediatric colonoscope was inserted into the stomach. The third duodenum was reached. Fluoroscopy assistance was necessary to locate the overtube, scope and also the metal barbs of the Endobarrier. Once the anchor site was reached we were able to collapse the anchor using the grasper and always under Fluoroscopy for visualization. The barbs were slowly but steadily pulled into the overtube and the device was detached from its embedded site and gradually brought into the stomach (Figure, Video). Once in the stomach we continued to pull the whole anchor into the overtube. We checked with both endoscopic and fluoroscopic views to ensure everything was safely in the tube and fully removed the device out of the esophagus. Relook endoscopy showed no active bleeding. A through-the-scope water-soluble contrast enterography demonstrated luminal integrity without leaks or perforation. The patient's clinical status improved and he was discharged home two days later.

Conclusions:

This case demonstrates a severe complication of endoscopic duodenojejunal bypass device (Endobarrier) and its endoscopic resolution using techniques and measures from the “extreme endoscopy toolbox”.