Endoscopic removal of eroded bands in vertical banded gastroplasty: a novel use of endoscopic scissors (with video)

Background: Vertical banded gastroplasty (VBG) as a surgical therapy for morbid obesity was first described in 1982. VBG involves partitioning the stomach with a vertical staple line and restricting the outlet pouch with a Gortex band. Complications of VBG include partial and total erosion of the band through the vertical staple line or through the lesser curvature into the gastric pouch. Band erosion occurs after surgery in 1% to 3% of patients, and patients may present with symptoms of obstruction, weight gain, nausea, pain, and bleeding. Unless a band has freely eroded from the stomach wall, allowing spontaneous elimination or simple endoscopic retrieval, surgical removal has been required heretofore. Previous attempts at endoscopic removal of eroded bands have included the use of neodymium-yttrium aluminum garnet laser ablation and other electrosurgical devices. Endoscopic scissors transection to remove an eroded laparoscopic band has been described in Europe but has not been performed in the United States. Objective: In this series, we describe the endoscopic removal of partially eroded bands embedded in the gastric wall by using flexible endoscopic scissors to sever and subsequently withdraw the bands endoscopically through the mouth. Conclusions: Eroded gastric bands have been safely removed endoscopically in 2 ambulatory outpatients. Design: Case series. Setting: Tertiary-care academic center. Main Outcome Measurements: Efficacy and safety. Limitations: Highly selected motivated patient population.