Gastric band erosion or penetration is a potentially serious complication following laparoscopic gastric band surgery for obesity.
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Epidemiology
Gastric band erosion is a delayed complication observed in between 0.3-14% of patients 1,2.
Clinical presentation
Patients often present non-specifically with epigastric pain, hematemesis, cessation or weight loss or port-site infection. Some authors have described patients as presenting with symptoms of gastric obstruction.
Turbid fluid content may be aspirated from the port site during routine examination, alerting clinicians of the possibility of intragastric erosion.
Pathology
Band erosion can occur due to discrete gastric wall injury sustained during band placement. Other causes include over distension of the band with the development of underlying gastric ischemia or inflammation. Postoperative adhesions and the use of NSAIDs are thought to further add to risks of band erosion.
It is often a chronic insidious process. Hence, it may be incidentally discovered on CT in patients with lap gastric bands for other reasons.
Radiographic features
Band erosion can be a challenging imaging diagnosis and endoscopic examination remains the definitive mode of evaluation.
Plain radiograph
This can demonstrate gastric band malposition as the erosion progresses and the band moves further into the gastric wall and lumen.
Fluoroscopy
Fluoroscopic examination can be normal in the early stages, especially when the erosion is incomplete. Eventually, oral contrast is seen pooling around the band at the point of erosion.
CT
This can demonstrate invasion of the band into the stomach wall. Once the mucosa is breached locules of extraluminal gas may be seen in the gastric wall underlying the band tubing.
Treatment and prognosis
Once intragastric erosion has been identified band erosion band removal is mandated. This can be performed laparoscopically or endoscopically. Following band removal upper GI fluoroscopy may be performed to assess for an ongoing leak.
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