Vertical banded gastroplasty (VBG) was introduced in 1982 as a restrictive form of
weight loss surgery through the creation of a pouch using a vertical staple line and
outlet restriction with a silastic band [1]. However, the popularity of VBG has waned due to high adverse event rates and the
need for surgical revision [2]. We present the case of an endoscopic reversal of a VBG using electroincision ([Video 1]).
Video 1 Endoscopic reversal of a vertical banded gastroplasty using electroincision.
A 49-year-old woman with a history of VBG presented with nausea, episodic vomiting,
and dysphagia. A computed tomography scan revealed no signs of obstruction ([Fig. 1]). Upper endoscopy demonstrated a large gastrogastric fistula at the staple line
with the silastic band eroding into the lumen ([Fig. 2]). Between the gastrogastric fistula and the eroded band, there was a septum of gastric
tissue. The tissue pedicles holding the silastic band were incised using a endoscopic
submucosal dissection knife, and the band was removed ([Fig. 3 a]). The decision was made to reverse the VBG given the patient’s symptoms and that
the size of the gastrogastric fistula precluded successful endoscopic closure. The
gastric septum was then divided ([Fig. 3 b]). Hemoclips were placed in areas of mild bleeding.
Fig. 1 Computed tomography demonstrated postoperative changes to the gastroesophageal junction
and a hiatal hernia, but no obstruction.
Fig. 2 Endoscopic findings. a Endoscopy revealed an eroded silastic band on the right and a gastrogastric fistula
on the left. b Diagram of the endoscopic findings in relationship to surgical anatomy.
Fig. 3 Endoscopic treatment using an electroincision knife. a The eroded silastic band was removed by excising the supporting tissue pedicles using
an electroincision knife. b Division of the gastrogastric fistula using an electroincision knife.
Repeat endoscopic examination 2 months later revealed a healed resection site with
complete reversal of her prior VBG anatomy ([Fig. 4]). The patient had complete resolution of all symptoms.
Fig. 4 Repeat endoscopy at 2 months post-procedure demonstrated reversed vertical banded
gastroplasty anatomy.
VBGs are associated with high rates of long-term failure due to band erosions, gastric
outlet stenosis, and inadequate weight loss [3]. Specifically, band erosions may occur after 1 % – 3 % of VBGs [4]. Methods for removal of eroded bands include the use of Nd:YAG laser, electroincision,
and electrosurgical scissors [5]. In our case, we used electroincision to remove the eroded band and also reverse
the VBG, resulting in durable symptom control. In conclusion, endoscopic reversal
of VBG can be considered in patients with similar presentations.
Endoscopy_UCTN_Code_CPL_1AM_2AF
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