Endoscopic Ultrasound-Guided Stented Gastro-Gastrostomy for Strictured Vertical Banded Gastroplasty
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MULTIMEDIA ARTICLE
Endoscopic Ultrasound-Guided Stented Gastro-Gastrostomy for Strictured Vertical Banded Gastroplasty Francesca Balsamo 1,2 & Nico Pagano 3 & Matteo Rottoli 1,2 Gilberto Poggioli 1 & Paolo Bernante 1,2
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Massimo P. Di Simone 1 & Andrea Sciannamea 1,2 &
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Herein, we make a video presentation of an endoscopic reversal of a strictured vertical banded gastroplasty (VBG), carried out through an endoscopic ultrasonography (EUS)-guided transluminal therapy system, in order to accurately identify the common gastric wall and to allow the application of an endoscopic stent. The operative time was 60 min, and no intraoperative complication was recorded. On postoperative day 1, an upper GI swallow showed the oral contrast easily flowing into the body of the stomach throughout the stent. A semi-solid diet was started on day 1. The postoperative course was uneventful, and the patient was discharged on day 2. At the 3-month follow-up visit, the patient denied further symptoms. The follow-up upper GI swallow and endoscopy showed a patent gastro-gastrostomy and no residual gastric pouch dilation or stagnation of the oral contrast, and the stent was therefore removed. Gastro-gastrostomy by endoscopic stenting appears to be an effective option to relief symptoms in strictured VBG, and EUS guidance has made access to the target structure easier and safer. Keywords Vertical banded gastroplasty . Endoscopic ultrasonography . Stent
Background Vertical banded gastroplasty (VBG) is often complicated by the onset of a stricture at the level of the band site, which might be associated with severe symptoms, such as dysphagia and regurgitation [1]. In these cases, the reversal of VBG is indicated, and the aim is to re-establish the original anatomy as closely as possible. Ideally, the prosthetic band should be removed to resolve the obstruction and to avoid further erosion of the gastric wall; however, this is not always technically feasible. A Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04773-0) contains supplementary material, which is available to authorized users. * Matteo Rottoli [email protected] 1
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Surgery of the Alimentary Tract, Sant’Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy Department of Medical and Surgical Sciences, Center for the Study and Research of Surgical Treatment for Morbid Obesity, Alma Mater Studiorum University of Bologna, Via Massarenti 9, 40138 Bologna, Italy Gastroenterology Unit, Sant’Orsola Hospital, Bologna, Italy
surgical gastro-gastrostomy represents an alternative choice, although the procedure is associated with risks of intra- and postoperative complications [2]. An endoscopic gastrogastrostomy was recently described: during the procedure, the common wall between the proximal pouch and the fundus was identified and dissected, in order for the bypass to be carried out. However, a blind dissection might be t
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