Gastroscopic Removal of an Adjustable Gastric Band after Partial Intragastric Migration

Regusci, Luca; Groebli, Y; Meyer, J L; Walder, J; Margalith, D.; Schneider, Rolf

doi:10.1381/096089203764467216

Cited by 79 publications

(38 citation statements)

References 10 publications

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“…We have defined three stages of migration depending on the degree of migration into the gastric lumen. Endoscopic removal is feasible provided that band has partially or totally migrated [16,21]. Nevertheless it requires specific equipments and skilled endoscopist.…”

Section: Discussionmentioning

confidence: 99%

Migration of adjustable gastric banding from a cohort study of 4236 patients

Nocca

Frering²,

Gallix

et al. 2005

Surg Endosc

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Section: Discussionmentioning

confidence: 99%

Migration of adjustable gastric banding from a cohort study of 4236 patients

Nocca

Frering²,

Gallix

et al. 2005

Surg Endosc

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“…An endoscopic approach with a device designed to cut the band (the Gastric Band Cutter, AMI) has been proposed, especially when the band has almost completely migrated into the stomach. 10 In our study, we review our experience with endoscopic removal of eroded gastric bands using this special endoscopic instrumentation.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic management of gastric band erosions: a 7-year series of 14 patients

Doğan

Akın

Yalakı

et al. 2014

cjs

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Background: Intragastric band migration is an unusual but major complication of gastric banding. We review our experience with endoscopic removal of eroded gastric bands. Methods:We retrospectively evaluated the cases of 110 morbidly obese patients who underwent adjustable gastric banding between 2005 and 2012 to identify those who experienced band erosion. To remove the migrated band, we used an endoscopic approach with a Gastric Band Cutter.Results: Band or tube erosion occurred in 14 patients (12.7%). The median time interval from the initial gastric band placement to the diagnosis of band erosion was 32 (range 18-52) months. Upper abdominal pain, port site infection, loss of restriction and weight regain were the most common symptoms. We used the Gastric Band Cutter to remove the band endoscopically. It was able to cut the band successfully in all but 1 patient, in whom twisting of the cutting wire required conversion from endoscopy to laparotomy. In 2 patients, the band, after being cut, was locked in the gastric wall and required laparotomic removal. In 1 patient, we performed surgery for intragastric pene tration of the connecting tube broken close to the band. Conclusion:The Gastric Band Cutter was successful in dividing the band in all but 1 patient, although we could not always complete the procedure endoscopically. Endoscopic removal seems to be effective and safe for band erosion.Contexte : La migration intragastrique de l'anneau est une complication rare, mais majeure du cerclage gastrique. Nous faisons le point sur notre expérience du retrait endoscopique des anneaux gastriques érodés.Méthodes : Nous avons évalué de manière rétrospective le cas de 110 patients atteints d'obésité morbide qui ont subi un cerclage gastrique ajustable entre 2005 et 2012 afin de vérifier si les anneaux en place étaient érodés. Pour retirer les anneaux qui avaient migré, nous avons utilisé l'approche endoscopique et un dispositif pour sectionner l'anneau gastrique.Résultats : L'anneau ou le tube s'est érodé chez 14 patients (12,7 %). L'intervalle médian entre la pose initiale de l'anneau gastrique et le diagnostic d'érosion a été de 32 (entre 18 et 52) mois. La douleur abdominale haute, l'infection du port d'accès, la diminution de la restriction et la reprise de poids ont été les symptômes les plus fréquents. Nous avons utilisé un dispositif pour sectionner l'anneau gastrique afin de retirer l'anneau par voie endoscopique. Le dispositif a permis de sectionner l'anneau avec succès chez tous les patients sauf 1; dans ce dernier cas, une torsion du fil à sectionner a nécessité la conversion de l'endoscopie en une laparotomie. Chez 2 patients, une fois sectionné, l'anneau est resté emprisonné dans la paroi gastrique et a nécessité une extraction laparotomique. Chez 1 patient, nous avons effectué une intervention chirurgicale en raison de la pénétration intragastrique de la tubulure de raccord sectionnée à proximité de l'anneau. Conclusion :Le dispositif servant à sectionner l'anneau gastrique a bien fonctionné chez tous les...

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“…Recently, Egberts et al [2], based on a literature review, reported that the rate of re-erosion with this strategy was low, with weight loss maintained at the same rate as that of other bariatric procedures. During the same period, the endoscopic band removal technique was developed [13,[36][37][38]. The endoscopic technique implies that 50 % or more of the band, together with its lock, had migrated into the gastric lumen.…”

Section: Discussionmentioning

confidence: 99%

Intragastric gastric band migration: erosion: an analysis of multicenter experience on 177 patients

Lorenzo

Furbetta

et al. 2012

Surg Endosc

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Background Laparoscopic adjustable gastric banding (LAGB) has proven to be a safe and effective surgical treatment for morbid obesity. It can be a simple, fast, reversible, anatomy-preserving procedure. Despite these advantages, its long-term efficacy came into question by the occurrence of complications such as intragastric band migration. Consistent information regarding this complication is still lacking. Treatment for migration is still being debated as well. Most of the inconsistencies of these data stem from the very low number of patients reported in single-center experiences or case reports. Lack of multicenter experience is evident. The aim of this study was to perform a retrospective analysis of data on intragastric migration in a large multicenter cohort of patients who underwent LAGB. Methods A retrospective multicenter study on LAGB patients was performed. Data had been entered into a prospective database of the Italian Group for LapBand Ò (GILB) since January 1997. Pars flaccida and perigastric positioning were considered along with different kinds of gastric bands by the same manufacturer. Time of diagnosis, mean body mass index (BMI), presentation symptoms, and conservative and surgical therapy of intragastric migration were considered. Results From January 1997 to December 2009, a total of 6,839 patients underwent LAGB and their data were recorded [5,660 females, 1,179 males; mean age 38.5 ± 18.2 years (range 21-62 years); mean BMI = 46.7 ± 7.7 kg/m 2 (range 37.3-68.3); excess weight (EW) 61.8 ± 25.4 kg (range 36-130); %EW 91.1 ± 32.4 % (range 21-112 %)]. A total of 177 of 6,839 (2.5 %) intragastric erosions were observed. According to the postoperative time of followup, the diagnosis of intragastric migration was made in 74 (41.8 %), 14 (7.9 %), 38 (21.4 %), 40 (22.6 %), 6 (3.4 %), and 4 (2.2 %) banded patients at 6-12, 24, 36, 48, 60, and 72 months after banding, respectively. Most of intragastric band migration during the first 2 years occurred in bands with no or a few milliliters of filling. In patients with late erosion, the bands were adjusted several times; no band was overfilled but one was filled to the maximum or submaximum with a maximum of two adjustments. Erosions diagnosed during the first 24 months were related to the experience of the surgical staff, while late erosions were not. Conclusions Intragastric band migration or band erosion is a rare, disturbing, and usually not life-threatening complication of gastric banding. Its pathogenesis is probably linked to different mechanisms in early (technical failure in retrogastric passage) or late (band management) presentation. It is usually asymptomatic and there is no pathognomonic presentation. A wide range of therapeutic options are available, from simple endoscopic or laparoscopic removal to early or late band replacement or other bariatric procedure. More experience and more studies are needed to lower its presentation rate and definitively clarify its pathogenesis to address the right therapeutic option.

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Gastroscopic Removal of an Adjustable Gastric Band after Partial Intragastric Migration

Abstract: The endoscopic technique is beneficial even when the intraluminal migration is partial.

Cited by 79 publications

References 10 publications

Migration of adjustable gastric banding from a cohort study of 4236 patients

Migration of adjustable gastric banding from a cohort study of 4236 patients

Endoscopic management of gastric band erosions: a 7-year series of 14 patients

Intragastric gastric band migration: erosion: an analysis of multicenter experience on 177 patients

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