A 47-year-old patient previously underwent laparoscopic gastric bypass for obesity
(body mass index 56.2 kg/m2) followed by gastric bypass Fobi ring (GBFR) placement 5 years later. The patient
was referred to the endoscopy unit due to epigastric pain, which eased on intake of
proton pump inhibitors or food. Initial gastroscopy examination showed that the GBFR
had migrated intragastrically. A second endoscopy was planned to extract the migrated
GBFR ([Video 1]).
Video 1 Endoscopic extraction of migrated gastric bypass Fobi ring.
We prepared the A.M.I. Aigner Gastric Band Cutter device (A.M.I. GmbH, Feldkirch,
Austria) by introducing a cutting wire through the endoscope working channel and passing
it through the migrated GBFR. We pulled out the endoscope together with the wire insertion.
The endoscope was re-inserted and the soft plastic ends of the wire were grabbed by
forceps and pulled out through the endoscope; both cut wire ends came out via the
mouth. A flexible wire guide was introduced and passed over the cutting wire to provide
a counterforce to the GBFR. The external ends of the cutting wire were inserted into
the handpiece and toggle, and the toggle was turned to pull and tighten the wire until
it cut through the migrated GBFR. After cutting the GBFR, a snare was used to grab
and extract the GBFR.
This case illustrates successful extraction of a GBFR using the Gastric Band Cutter
device after the GBFR slipped and eroded through the gastric stump, causing gastric
stump obstruction. To date, surgery has been the most widely used method to remove
a similar device (i. e. a gastric band); however, the surgical approach has higher
morbidity. A retrospective analysis by Collado-Pacheco et al. showed that endoscopic
removal of a migrated gastric band is a feasible and safe procedure [1]. Similar results were shown in a study by Aarts et al., where endoscopic removal
of the migrated gastric band was also a feasible technique [2]. Endoscopic removal can be used as a first-choice procedure in clinical practice
[3]. The procedure for the removal of a GBFR is similar to that used for gastric band
removal.
Endoscopy_UCTN_Code_TTT_1AO_2AL
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