Endoscopic Removal of Noneroded Nonadjustable Gastric Bands Using Induced Mucosal Erosion With a Stent, and Review of the Literature

Abstract

Background. Laparoscopic removal of noneroded nonadjustable gastric bands (NAGBs) may lead to major life-threatening complications. A minimally invasive approach involving endoscopic removal by induced mucosal erosion with a stent (IMES) has been used in a few publications to remove NAGBs. Objective. To examine a minimally invasive endoscopic approach to removal of a NAGB. Setting. A large tertiary/quaternary referral hospital. Methods. We report 4 patients that underwent IMES at our institution and present a literature review of published cases. The procedure includes using an endoscopically placed fully covered stent through the NAGB stricture to cause erosion of the mucosa where the stent is putting direct pressure. After a predetermined length of time, the stent is removed with the NAGB and without a laparoscopic or open procedure. Primary endpoint for our cohort was successful removal to the NAGB with IMES. Secondary endpoints included interval of time to retrieval of the stent, complications from IMES, presenting symptoms, and type of NAGB. These endpoints were then compared with previous publications indicating the use of IMES. Results. Three of 4 patients were female with a mean age of 64.5 years. All patients had the NAGB successfully removed with IMES. The mean time for NAGB and stent removal after insertion was 17.5 days. No major complications were noted. Two patients had post-IMES strictures and were managed by balloon dilation. Conclusion. Endoscopic removal of NAGBs is a safe and feasible procedure for NAGB removal and can be used in place of laparoscopic surgery.