Endoscopic Removal of Non-Eroding Gastric Bands post SRVG Using Lumen-Apposing Metal Stents: A Viable Alternative to Traditional Endoscopic and Surgical Methods

Aims Endoscopic removal of gastric bands has emerged as a viable alternative to surgical methods for addressing band complications including epigastric pain, reflux, vomiting, and intragastric erosion. This technique is increasingly being recognized for its safety, effectiveness, and minimally invasive nature. To date, most endoscopic removals are only possible after the band has spontaneously eroded into the gastric lumen. Bands that have not eroded were removed with self-expanding metal/plastic stents (SEMS/SEPS) with relatively high adverse events rate. We hypothesized that using the newly developed lumen-apposing metal stent (LAMS) originally designed for transluminal drainage would be a safer alternative with minimal complications. This study aims to demonstrate the efficacy, safety, and clinical outcomes of LAMS for the treatment of gastric band removal [1] [2] [3].

Methods Ten patients post SRVG with symptoms of obstruction such as emesis, dysphagia, or regurgitation but without band erosion underwent endoscopic LAMS placement to induce erosion and migration of the band into the stomach. After two months, a second endoscopy was scheduled to evaluate stent-induced erosion and remove the stent and band. All patients had post-interventional follow-ups at the clinic or by phone.

Results All 10 patients underwent successful LAMS placement followed by endoscopic band and stent removal without periprocedural complications and were discharged up to 24 hours post-procedure. Four (40%) required additional endoscopic balloon dilatations to relieve gastric stenosis. The incidence of emesis decreased dramatically post-procedure, with only 2 patients (20%) reporting emesis after band removal compared to all patients before the intervention. Furthermore, we observed a significant reduction in the mean Eckardt symptom score, from 4.3 to 1.4.

Conclusions To our knowledge, this is the first study to use LAMS for stent-induced erosion and endoscopic removal of gastric bands. Our study shows that band removal using LAMS is a safe and effective technique without periprocedural complications. However, given our small sample size and single-arm design, a larger cohort with a control group and a more diverse patient population is recommended to definitively establish the efficacy and safety profile of this novel approach.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

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