498. LATROGENIC ESOPHAGEAL DISEASE POST OBESITY TREATMENT: SEVERE ESOPHAGEAL DILATATION RELATED TO ADJUSTABLE GASTRIC BANDING (AGB)
Authors: Franco Andrea Sánchez , Fernández Omar Abdel-lah , Alaejos Enrique Moro , Diez Beatriz Faus , Domínguez Susana María Martín , Muñoz Sonsoles Garrosa , Arranz Juan Manuel Nieto , Salvador Beatriz Barón , López Isaac Tapiador , Montiel Andrea Eduardo Valera , Jurado Manuel Jose Torres , Lobo Antón Sánchez , Parra Juan Sebastian Vargas , Cosido Lourdes Hernandez , Perfecto Ricardo Vazquez , Valverde Pedro Antonio Montalban , Manchado Felipe Carlos Parreño 
Published: September 2024

Iatrogenic Esophageal Disease post obesity treatment: severe esophageal dilatation related to adjustable gastric banding (AGB)

Introduction

Obesity is considered one of the biggest epidemics of the 21st century, which pushes us as health professionals to seek for solutions to this pathology. Within the medical-surgical approach, the most used techniques are gastric bypass, vertical gastrectomy and adjustable gastric banding (AGB). Even though they are frequently used, they are not free of complications. In this communication based on a case we would like to comment on the main complications of the use of the gastric band. These side effects has being between 0.5-5% to 20%: stoma stenosis, band slippage, intraluminal erosion, gastric volvulus and perforation.

Clinical Case

54-year-old woman underwent surgery 20 years ago for obesity using a restrictive technique with adjustable gastric banding. The patient began 18 years later with retrosternal pain, epigastric pain, vomiting and dysphagia. Endoscopic tests revealed esophageal dilation with retention of food remains, tortuous and macerated mucosa; said achalasia was caused by a gastroesophageal stenosis.

Among the diagnostic tests, an esophageal-gastric-duodenal barium transit was performed, showing a decrease in peristalsis with diffuse esophageal dilation of up to 7cm in diameter. Stenosis was observed in the lower esophageal third at the level of the esophagogastric junction of approximately 16 x 11 mm in longitudinal and transverse diameters.

Evolution

Surgical removal of the device is decided by a multidisciplinary team. Laparoscopic release of the gastric band was performed with electrocautery following adhesions around the device. Complete withdrawal upon release. Intraoperative endoscopy was performed, showing significant esophageal dilation with retained fermented food remains, mucous membrane affected by esophageal candidiasis. After the esophagogastric junction, a gastric fibrous ring was evidenced at the place of location of the gastric band, with good passage without evidence of gastric or esophageal lesions. Favorable postoperative evolution, being discharged 24 hours after surgery. After the case we observed the failure of the safety mechanism of the gastric band that regulates the internal diameter of the device due to the formation of a fibrotic constriction ring. Removal of the device improves the symptoms without requiring, in this case, section of the constriction ring. Currently, the patient shows improvement in her symptoms 6 months after the bariatric revision surgery.