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, 11 (4), 497-503

Endoscopic Treatment of Diverse Complications Caused by Laparoscopic Adjustable Gastric Banding: A Study in Eastern Asia

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Endoscopic Treatment of Diverse Complications Caused by Laparoscopic Adjustable Gastric Banding: A Study in Eastern Asia

Su Young Kim et al. Gut Liver.

Abstract

Background/aims: The use of laparoscopic adjustable gastric banding (LAGB) is increasing proportionally with the obesity epidemic. However, some postoperative complications have been highlighted as major problems associated with LAGB. There is no consensus concerning the endoscopic management of these adverse events. The aim of this study was to retrospectively review the feasibility and effectiveness of endoscopic treatment for LAGB complications.

Methods: We retrospectively evaluated 352 patients who underwent LAGB between 2011 and 2015. LAGB-associated complications developed in 26 patients (7.4%). This study involved six patients (1.7%) who received endoscopic treatment.

Results: Types of LAGB-induced complications in our series included intragastric migration (n=3), gastric leaks (n=2), and gastric fistulas (n=1). The endoscopic treatment of these complications was successful in four of the six patients. Endoscopic band removal was successful in two patients. All gastric leaks were successfully closed via an endoscopic procedure. In two cases (intragastric migration and gastric fistula), endoscopic treatment was not sufficient, and surgery was performed.

Conclusions: Endoscopic procedures afforded acceptable treatment of band migration and gastric leaks after LAGB. However, the results were poor in patients with gastric fistula.

Keywords: Bariatric surgery; Complication; Endoscopy.

Conflict of interest statement

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Endoscopic images from patient number 2. (A) Endoscopic appearance of band migration (dysfunction type IIIb). (B) Endoscopic removal was attempted when the buckle of the band entered the stomach. (C) Endoscopic view of a band removed via the mouth. The band had not been cut and was removed intact.
Fig. 2
Fig. 2
Endoscopic images from patient number 4. (A) A T-tube was placed in the leakage site. (B) After the tube was removed, fibrin glue was injected into the fistula.
Fig. 3
Fig. 3
Images of the fistula after the second bariatric surgery in patient number 5. (A) An over-the-scope clip was applied to the fistula. (B) Endoscopic images of the self-expandable metal stent (Shim’s technique) across the fistula.
Fig. 4
Fig. 4
Images of the leak after the second bariatric surgery in patient number 6. (A) An upper gastrointestinal (UGI) image of the gastric leak. The arrows show the contrast material outside the stomach. (B) Endoscopic view of cyanoacrylate injection into the leakage site. The arrow shows the leak orifice. (C) UGI image showing no visible contrast through the stomach wall.

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