342 An Interesting Report of Endoscopic Management of a Migrated Gastric Lap Band

Abstract

INTRODUCTION: Laparoscopic adjustable gastric band (LAGB) placement is a commonly performed surgical weight loss procedure. Erosion of the band through the gastric wall is an uncommon albeit life-threatening complication that can present with abdominal pain and weight gain, potentially leading to peritonitis. Diagnosis is made with imaging such as computed tomography (CT) and may be managed by endoscopic or surgical intervention. We report a case of a LAGB that eroded through the gastric wall and migrated into the jejunum, managed with successful endoscopic retrieval. CASE DESCRIPTION/METHODS: 58-year-old male with a history of class III obesity status post LAGB placement in 2008 presented with two months of abdominal pain, nausea, vomiting and weight loss. CT abdomen revealed mural thickening of gastric cardia with distal end of the gastric band tubing attached to a band in the jejunum and proximal end of tubing attached to a subcutaneous port (Figure 1). Fluoroscopy-guided enteroscopy revealed multiple mucosal ulcerations due to tracking of the displaced gastric band tubing. The tubing was noted to enter the gastric cavity at the cardia, extending into the proximal jejunum where the deflated gastric band was identified. A snare was used to pull the band into the gastric cavity. An upper endoscope was then inserted alongside the enteroscope (Figure 2). A 0.025 inch guidewire was placed around the tubing and captured with a snare. The distal end of the guidewire was then removed along with the gastroscope through the oral cavity. Both ends of the guidewire were loaded into a Sohendra rescue lithotripter which was then used to severe the lap band tubing approximately 10 cm from the point of entry into the gastric cavity. The resected band remained secure in the snare and was removed along with the enteroscope from the oral cavity (Figure 3). The subcutaneous port with residual gastric tubing was surgically removed two weeks later. DISCUSSION: LAGB erosion is an uncommon late complication of band placement. Endoscopic removal of an eroded band represents an important modality for the management of this complication and an important minimally-invasive alternative to surgery. While patients typically present with weight gain, our patient presented with weight loss likely due to intermittent obstruction. There are several reported cases of endoscopic retrieval. Our case highlights that endoscopic management should be considered as the initial treatment for eroded LAGB. Watch the video: http://bit.ly/2XPqnPS