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Peroral endoscopic extraction of an eroded laparoscopic gastric band
VideoGIE
PATENT is an access technique that offers secured expansion of freshly created cutaneous tracts with a prosthetic device to enable simultaneous combined transprosthetic and endoscopic procedures to be performed by using therapeutic flexible endoscopes at a target site not accessible via the natural orifice. In this case, a fully covered esophageal metal stent was placed over a wire through an interventional radiology–placed percutaneous drain to allow access to the serosal aspect of the anastomotic leak and performance of a combined, fullthickness, mucosal and serosal repair of the defect by using endoclips (Fig. 1). PATENT is a minimally invasive hybrid approach that capitalizes on the capacity of radiologically guided percuta-
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.
neous entry points to provide access into segments of the GI tract not feasible with traditional endoscopy. PATENT has the interventional versatility of traditional flexible endoscopy that can be used to solve a variety of challenging clinical conundrums. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. No Editors acted as reviewer for this article. Barham K. Abu Dayyeh, MD, MPH, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, Todd H. Baron, MD, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, Navtej Buttar, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
http://dx.doi.org/10.1016/j.gie.2014.05.005
Peroral endoscopic extraction of an eroded laparoscopic gastric band
Figure 1. A, Ring of the eroded laparoscopic gastric band captured within the loop of a stiff 0.035-inch guidewire. The sheath of the rescue lithotriptor is evident (arrow). B, Laparoscopic gastric band after peroral extraction. The endoscopically fractured ring is evident (arrow).
Laparoscopic gastric band (LAGB) is a silicon ring with an adjustable fluid reservoir inserted around the cardia of the stomach to facilitate weight loss. Transmucosal erosion of an LAGB has been reported in as many as 4% of patients. Surgical extraction is technically challenging because of a dense, fibrous capsule that surrounds the LAGB. Endoscopic extraction is gaining recognition in the setting of high rates of success and few adverse events. An adult gastroscope was advanced to the level of the eroded laparoscopic gastric band. A guidewire was
advanced between the ring of the LAGB and the gastric wall through a gastroscope. The gastroscope was exchanged, reintroduced, and the distal end of the guidewire was grasped with a snare, extracted through the mouth approximating both ends of the guidewire, which created a loop around the ring. The sheath of a rescue lithotripter was advanced over both ends of the guidewire to the ring. The winch of the mechanical lithotripter retracted the guidewire into the sheath, fracturing the ring (Fig. 1; Video 1, available online at www.giejournal.org).
456 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 2 : 2015
www.giejournal.org
VideoGIE
The procedure was performed in the operating room, enabling the surgical team to deliver the subcutaneous LAGB port through a 5-cm excision and sever the tubing to the port. The LAGB was then extracted with a snare through the mouth without adverse events.
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.
DISCLOSURE All authors disclosed no financial relationships relevant to this article. Jeffrey J. Easler, MD,1 J. Christopher Eagon, MD,2 Faris M. Murad, MD,1 Divisions of Gastroenterology and Hepatology (1) and General Surgery and Minimally Invasive Surgery (2), Washington University School of Medicine, St. Louis, Missouri, USA
http://dx.doi.org/10.1016/j.gie.2014.05.314
Endoscopic removal of a transgastric eroded laparoscopic adjustable silicone gastric band
Figure 1. Upper endoscopy showing a partial transgastric migration of the LASGB.
A known adverse event of gastric banding for morbid obesity is the trans- or intragastric migration of the laparoscopic adjustable silicone gastric band (LASGB); the estimated risk is as high as 1%. A patient, with suspected band migration caused by unexpected weight gain, underwent an upper endoscopy showing a partial transgastric migration of the LASGB. With the patient under local anesthesia, the injection port and the silicone connecting tube were resected. The band was then retrieved endoscopically by using a polypectomy snare placed over the notch on the
band. A standard ERCP guidewire was inserted between the partially migrated LASGB and the stomach wall and again picked up at the other side of the LASGB, creating a noose around the band. Both ends of the guidewire were externalized through the mouth. The metal spiral sheath of a mechanical ERCP lithotriptor was passed over both ends, which were wound up until the LASGB was cut. Both parts of the band were retrieved endoscopically by using a polypectomy snare (Fig. 1; Video 1, available online at wwwgiejournal.org). A minimally invasive technique for
www.giejournal.org
Volume 81, No. 2 : 2015 GASTROINTESTINAL ENDOSCOPY 457
PATENT is an access technique that offers secured expansion of freshly created cutaneous tracts with a prosthetic device to enable simultaneous combined transprosthetic and endoscopic procedures to be performed by using therapeutic flexible endoscopes at a target site not accessible via the natural orifice. In this case, a fully covered esophageal metal stent was placed over a wire through an interventional radiology–placed percutaneous drain to allow access to the serosal aspect of the anastomotic leak and performance of a combined, fullthickness, mucosal and serosal repair of the defect by using endoclips (Fig. 1). PATENT is a minimally invasive hybrid approach that capitalizes on the capacity of radiologically guided percuta-
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.
neous entry points to provide access into segments of the GI tract not feasible with traditional endoscopy. PATENT has the interventional versatility of traditional flexible endoscopy that can be used to solve a variety of challenging clinical conundrums. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. No Editors acted as reviewer for this article. Barham K. Abu Dayyeh, MD, MPH, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, Todd H. Baron, MD, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, Navtej Buttar, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
http://dx.doi.org/10.1016/j.gie.2014.05.005
Peroral endoscopic extraction of an eroded laparoscopic gastric band
Figure 1. A, Ring of the eroded laparoscopic gastric band captured within the loop of a stiff 0.035-inch guidewire. The sheath of the rescue lithotriptor is evident (arrow). B, Laparoscopic gastric band after peroral extraction. The endoscopically fractured ring is evident (arrow).
Laparoscopic gastric band (LAGB) is a silicon ring with an adjustable fluid reservoir inserted around the cardia of the stomach to facilitate weight loss. Transmucosal erosion of an LAGB has been reported in as many as 4% of patients. Surgical extraction is technically challenging because of a dense, fibrous capsule that surrounds the LAGB. Endoscopic extraction is gaining recognition in the setting of high rates of success and few adverse events. An adult gastroscope was advanced to the level of the eroded laparoscopic gastric band. A guidewire was
advanced between the ring of the LAGB and the gastric wall through a gastroscope. The gastroscope was exchanged, reintroduced, and the distal end of the guidewire was grasped with a snare, extracted through the mouth approximating both ends of the guidewire, which created a loop around the ring. The sheath of a rescue lithotripter was advanced over both ends of the guidewire to the ring. The winch of the mechanical lithotripter retracted the guidewire into the sheath, fracturing the ring (Fig. 1; Video 1, available online at www.giejournal.org).
456 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 2 : 2015
www.giejournal.org
VideoGIE
The procedure was performed in the operating room, enabling the surgical team to deliver the subcutaneous LAGB port through a 5-cm excision and sever the tubing to the port. The LAGB was then extracted with a snare through the mouth without adverse events.
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.
DISCLOSURE All authors disclosed no financial relationships relevant to this article. Jeffrey J. Easler, MD,1 J. Christopher Eagon, MD,2 Faris M. Murad, MD,1 Divisions of Gastroenterology and Hepatology (1) and General Surgery and Minimally Invasive Surgery (2), Washington University School of Medicine, St. Louis, Missouri, USA
http://dx.doi.org/10.1016/j.gie.2014.05.314
Endoscopic removal of a transgastric eroded laparoscopic adjustable silicone gastric band
Figure 1. Upper endoscopy showing a partial transgastric migration of the LASGB.
A known adverse event of gastric banding for morbid obesity is the trans- or intragastric migration of the laparoscopic adjustable silicone gastric band (LASGB); the estimated risk is as high as 1%. A patient, with suspected band migration caused by unexpected weight gain, underwent an upper endoscopy showing a partial transgastric migration of the LASGB. With the patient under local anesthesia, the injection port and the silicone connecting tube were resected. The band was then retrieved endoscopically by using a polypectomy snare placed over the notch on the
band. A standard ERCP guidewire was inserted between the partially migrated LASGB and the stomach wall and again picked up at the other side of the LASGB, creating a noose around the band. Both ends of the guidewire were externalized through the mouth. The metal spiral sheath of a mechanical ERCP lithotriptor was passed over both ends, which were wound up until the LASGB was cut. Both parts of the band were retrieved endoscopically by using a polypectomy snare (Fig. 1; Video 1, available online at wwwgiejournal.org). A minimally invasive technique for
www.giejournal.org
Volume 81, No. 2 : 2015 GASTROINTESTINAL ENDOSCOPY 457