Endoscopic treatment of band erosion

Background. Band erosion is a major late complication of gastric banding, always requiring band removal; its frequency ranges from 0,5 to 3,8%. Different methods, laparotomic, laparoscopic or endoscopic, are currently used to remove the band. Methods. 741 morbid obese patients underwent laparoscopic adjustable gastric banding in our Department since 1998. We observed 13 band erosions, 4 in our patients, and 9 in patients who were referred to our Center from other hospitals. In 2 patients we had to remove the band surgically, in one case for port-site infection associated with subphrenic abscess, in the other case for gallstone-related acute pancreatitis, associated with complete band migration in jejunum. In the other 11 patients we used an endoscopic approach with the Gastric Band Cutter, a device designed to cut the band (A.M.I. Agency for Medical Innovation GmbH, Götzis, Austria). Results. We could remove the migrated band endoscopically in all cases except two: in one case a twisting of the cutting wire in the area of cardia required conversion to laparoscopy, in the other the band was successfully cut but was blocked in the stomach, and was then removed in laparotomy. Conclusions. In nearly all cases the Gastric Band Cutter proved successful in cutting the band, even if not all bands could be removed endoscopically. In our experience this method seems to be the first choice for the treatment of band erosion. It is advisable to do it in the operating room for the possible complications of the procedure.