Marcelo Falcão

Endoscopic removal of eroded adjustable gastric band: lessons learned after 5 years and 78 cases

BACKGROUND One of the complications of laparoscopic adjustable gastric banding is intragastric erosion, leading to a revisional procedure to remove the band. Our aim was to present the procedure and results of endoscopic band removal in a 5-year multicenter experience from the Gastro Obeso Center and Universidade de São Paulo, São Paulo, and Universidade Federal de Pernambuco, Recife, Brazil. METHODS From 2003 to 2008, 82 patients were diagnosed with band erosion. The clinical data concerning the endoscopic procedure were prospectively recorded and retrospectively reviewed. RESULTS The average preoperative body mass index was 43.2 kg/m(2) (range 34-50). At the diagnosis of intragastric erosion, the body mass index was 24-41 kg/m(2) (average 31.8). The erosion occurred an average of 16.3 months (range 6-36) postoperatively. The symptoms included pain in 25 (31%), port infection in 21 patients (27%), and weight regain in 20 (25%), and 12 patients (15%) were asymptomatic. Endoscopic removal was possible for 78 patients (95%). In 85% of patients, the band was removed in the first session, with an average duration of 55 minutes (range 25-150). Five cases of pneumoperitoneum occurred after the procedure. Of these, 3 were treated conservatively, 1 was treated by laparoscopy, and 1 was treated by abdominal puncture using the Veress needle. CONCLUSION Endoscopic removal of eroded laparoscopic adjustable gastric banding is safe and effective. It can be used as a first choice procedure in clinical practice.

Colangiopancreatografía retrógrada endoscópica en pacientes con asa en Y-de-Roux

Endoscopic retrograde cholangiopancreatography in Roux-en-Y patients The reconstruction of the digestive tract with a Roux-en-Y anastomosis has been performed more fre- quently in the last years mainly due to the overgrowth in the surgical treatment of obesity by gastric bypass in Roux-en-Y. The obesity pandemic is also associated with an increase in both the preoperative and postoperati- ve diagnosis of gallstones in this population. Bearing in mind the greater complexity of endoscopic retrograde cholangiopancreatography in these circumstances, the authors have reviewed the various endoscopic appro- aches available, evaluating 249 articles published between 1990 and 2010 obtained from Medline, Cochrane and Scielo, excluding case reports and articles outside the specifi c scope of this study. Endoscopic techniques with high success rates include the use of enteroscope, colonoscope, enteral and transgastric access combined with surgery. Even with the technological progress already made, further development of the instruments used will be necessary if greater comfort and safety is to be achieved with this procedure.