Discussion: Adverse effects related to GES use include disruption of lead placement, erosion in the submucosa or mucosa, and obstruction, with generator site infection as the most common issue. Studies have shown that lead penetration into the gastric lumen occurs in 3% of patients, with 16% of patients requiring a corrective surgical procedure. This patient's presentation demonstrates a rare event after GES placement. Typically, leads are placed in the muscularis propria of the greater gastric curvature. Lead displacement can be detected either on imaging or if impedance values are outside the normal range; however, neither of those occurred in this patient. Abnormal presentations demonstrated by patients with GES should be evaluated thoroughly, with suspicion for hardware malposition. Diagnostic work-up with endoscopy can guide further management.[3586] Figure 1. A: Upper endoscopy revealing linear, subepithelial protrusions at the greater curvature of the antrum, located approximately 10 cm from the pylorus, consistent with typical gastric stimulator leads Figure B: Abdominal x-ray showing an anterior view of gastric pacer generator and lead placement.

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