Laparoscopic removal of non-eroded bariatric gastric bands may lead to major complications
[1]. A minimally invasive approach involving endoscopic removal is a less risky option
[2]. The stent-induced mural erosion technique using self-expandable plastic stents
has been reported a few times [3]
[4]
[5]. The use of a fully covered self-expandable metal stent (FCSEMS) is anecdotally
reported [1].
A 53-year-old woman with a history of morbid obesity who had undergone bariatric surgery
using a nonadjustable banded vertical gastroplasty 20 years previously presented with
daily repeated vomiting and gastroesophageal reflux disease. Upper gastrointestinal
(GI) endoscopy revealed the proximal stomach (above the gastric band), which was deformed
by excessive dilation, and a concentric ring secondary to band compression, without
endoscopic exteriorization, and covered by preserved mucosa.
Endoscopic removal of the gastric band was planned. In the first step, an esophageal
FCSEMS (155 × 23 mm; WallFlex) was successfully placed, with the proximal end deployed
above the gastric band compression and the distal end of the stent released 5 cm distally
to the ring ([Fig. 1] and [Fig. 2]). In the second step performed after 2 weeks, a second upper GI endoscopy was scheduled
to retrieve the FCSEMS and for en bloc removal of the band. The intra-stent endoscopic
view allowed visualization of the white band, which was already visible because of
erosion of the gastric wall induced by the stent. Removal of the FCSEMS using a grasping
foreign body forceps (Rat Tooth/Alligator Grasping Forceps; Rescue Combo, Boston Scientific)
and guided by fluoroscopy and endoscopy was performed without incident. The subsequent
endoscopic view showed a total and surprising visualization of the nonadjustable bariatric
band, externalized to the gastric cavity, which therefore allowed its en bloc removal
using the same grasping forceps without any adverse events ([Fig. 3], [Fig. 4] and [Fig. 5]; [Video 1]).
Fig. 1 Endoscopic image of the gastric ring related to the gastric band compression.
Fig. 2 Fluoroscopic image of the deployed fully covered self-expandable metal stent showing
an hourglass shape due to the gastric band compression.
Fig. 3 Endoscopic view of the gastric band identified after retrieval of the fully-covered
self-expandable metal stent.
Fig. 4 The nonadjustable gastric band after its removal using the fully covered self-expandable
metal stent-induced erosion technique.
Fig. 5 Endoscopic view showing the stenotic area left after en bloc removal of the gastric
band.
Video 1 Removal of a bariatric band using a gastric mural erosion technique induced with
a fully covered self-expandable metal stent.
Endoscopic removal of a nonadjustable bariatric band using an esophageal FCSEMS-induced
gastric mural erosion technique seems to be feasible and effective, and could allow
easier extraction of the band than using a plastic stent.
Endoscopy_UCTN_Code_CPL_1AH_2AK
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