Page 37 - Read Online

Page 6 of 8 Ardila-Gatas et al. Mini-invasive Surg 2020;4:16 I http://dx.doi.org/10.20517/2574-1225.2019.69

Figure 4. Band erosion [5]

endoscopist hands, an endoscopic retrograde cholangiopancreatography (ERCP) is successful 60% of the
[2-4]
time in these patients . The most common route used is to laparoscopically get access to the gastric
remnant and through there get access to the papilla. An alternative is to use endoscopic ultrasound to
create a gastrogastric fistula with SEMS placement, through which the scope can enable access to the
[2,6]
papilla and subsequent ERCP . Closure of the resultant gastrogastric fistula following this procedure is
not well studied.

BAND EROSION
Even though laparoscopic gastric banding has decreased in popularity due to its long-term complications
and lack of sustained weight loss, its complications are still relatively common presentations in bariatric
centers.

[2]
Transmural migration of the band through the gastric wall occurs in 7% of gastric banding patients .
Endoscopy plays a role in the diagnosis and treatment of this complication. Endoscopic removal of
eroded bands has been described [2-4] . With the use of ultrasonic shears, or preferably placing a wire
around the band and using an ERCP rescue device, the band and tubing complex can be cut and removed
transorally [Figure 4]. Endoscopic removal is most likely to be successful if the band buckle is within
[18]
the gastric lumen. Traditionally, removal of the band is performed with a combination of laparoscopy and
endoscopy [2,18] .

GASTROESOPHAGEAL REFLUX DISEASE
As the rate of sleeve gastrectomy procedures performed in the US increases, the rate of de novo
[4,5]
gastroesophageal reflux disease (GERD) after surgery and new-onset Barrett’s esophagus has increased .
The use of novel endoscopic techniques to address GERD after bariatric surgery has slowly gained
popularity. Several case reports have been published with successful results. The use of radiofrequency
energy (Stretta) is the most widely described. The antireflux mucosectomy procedure involves endoscopic
mucosal resection of the gastroesophagic junction and is also described [10,19] . The healing of the mucosal
[19]
defect stimulates scar formation that improves reflux . Further studies are needed to evaluate the long-
term success of this approach.

SUMMARY
As the incidence of obesity increases exponentially, so does the incidence of bariatric surgery performed
in the US. Complications of these procedures can present days to years postoperatively. Many of these
complications can be managed endoscopically. Advances in endoscopic techniques have facilitated a