Endoscopy 2021; 53(02): E77-E78
DOI: 10.1055/a-1195-2191
E-Videos

Bariatric gastric band removal using a gastric mural erosion technique induced with a fully covered self-expandable metal stent

Julio G. Velasquez-Rodriguez
1  Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
,
Amador Garcia Ruiz de Gordejuela
1  Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
2  Surgical Department, Hospital Universitari de Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
,
Joan B. Gornals
1  Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain
3  Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
› Author Affiliations
 

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]).

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Fig. 1 Endoscopic image of the gastric ring related to the gastric band compression.
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Fig. 2 Fluoroscopic image of the deployed fully covered self-expandable metal stent showing an hourglass shape due to the gastric band compression.
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Fig. 3 Endoscopic view of the gastric band identified after retrieval of the fully-covered self-expandable metal stent.
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Fig. 4 The nonadjustable gastric band after its removal using the fully covered self-expandable metal stent-induced erosion technique.
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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.


Quality:

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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Competing interests

J. B. Gornals is a consultant for Boston Scientific. The remaining authors declare that they have no conflict of interest.


Corresponding author

Joan B. Gornals, MD, PhD
Endoscopy Unit, Dept. of Digestive Diseases
Hospital Universitari de Bellvitge-IDIBELL (Bellvitge Biomedical Research Institute)
Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat
Barcelona, Catalonia
Spain   
Fax: +34-93-2607681   

Publication History

Publication Date:
26 June 2020 (online)

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany


Zoom Image
Fig. 1 Endoscopic image of the gastric ring related to the gastric band compression.
Zoom Image
Fig. 2 Fluoroscopic image of the deployed fully covered self-expandable metal stent showing an hourglass shape due to the gastric band compression.
Zoom Image
Fig. 3 Endoscopic view of the gastric band identified after retrieval of the fully-covered self-expandable metal stent.
Zoom Image
Fig. 4 The nonadjustable gastric band after its removal using the fully covered self-expandable metal stent-induced erosion technique.
Zoom Image
Fig. 5 Endoscopic view showing the stenotic area left after en bloc removal of the gastric band.