Jefferson Tran, , Aaron Cernero, DO, Katrina Sykes, , Thomas Tran, MD TMC, Denison, TX
Introduction: Gastric band erosion is a feared complication of laparoscopic adjustable gastric banding (AGB). We report a case of life-threatening band erosion that required multidisciplinary management.
Case Description/Methods: The patient is a 55-year-old man with a history of morbid obesity treated with AGB in Mexico 7 years ago. He presented to the ER with acute severe epigastric abdominal pain, nausea, vomiting, intolerance of any oral intake. CT scan showed band erosion into the stomach with the band wrapping around the left gastric artery. The patient was admitted by the hospitalist service. Surgery and GI were consulted, and the patient was taken to the OR. Intra-operative EGD showed 90% of the band was intra-gastric with 10% embedded in the gastric cardia. Surgical removal of the band was performed. Post-op, the patient developed abdominal abscesses, requiring surgical washout and wound vacuum placement. Infectious disease placed him on IV antibiotics. TPN was initiated and managed by the nutrition service. The patient developed profuse hematemesis. EGD showed a large amount of blood mixed with clots in the esophagus and stomach. After several days of IV pantoprazole and metoclopramide, EGD was repeated which showed two fistulas in the gastric cardia. A 15.5 cm x 2.3 cm gastro-esophageal stent was placed under fluoroscopy to cover the fistulas. Gastrograffin study showed no leakage. Three days later, he developed severe left chest pain. CT showed a moderate left pleural effusion. Repeat gastrograffin study showed no leakage from the esophagus or the stomach. Pulmonary service performed a thoracentesis which showed reactive pleural effusion. The patient had physical therapy and occupational therapy to regain his strength. After 2 weeks of hospitalization, he was discharged in stable conditions. EGD was repeated 1 month later with removal of the stent. The patient has done well with no recurrence of symptoms.
Discussion: Band erosion through the wall of the stomach has been reported in about 7% of AGB patients, most likely as a result of gastric wall ischemia from a tight band. Erosion can lead to fistulas, abscess, bleeding, and death. Immediate treatment is required with removal of the band and possible endoscopic clipping or stenting. As illustrated in this report, a multidisciplinary approach (ER, radiology, hospitalist, surgery, GI, anesthesia, infectious disease, pulmonary, nutrition, wound care, physical therapy, occupational therapy, social work, etc.) is needed to lead to an optimal outcome.
Disclosures:
Jefferson Tran indicated no relevant financial relationships.
Aaron Cernero indicated no relevant financial relationships.
Katrina Sykes indicated no relevant financial relationships.
Thomas Tran indicated no relevant financial relationships.
Jefferson Tran, , Aaron Cernero, DO, Katrina Sykes, , Thomas Tran, MD. P2625 - Life-threatening Gastric Erosion After Laparoscopic Adjustable Gastric Banding: A Multidisciplinary Management, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
