Endoscopic Management of Vertical Banded Gastroplasty Stricture: Feasibility, Safety, and Efficacy

Background: Although vertical banded gastroplasty (VBG) is no longer performed in the USA, due to its popularity in 1980s, many patients still possess this anatomy with its inherent complications. The stomal stenosis secondary to tight ring or mesh is traditionally treated with surgical removal of the silastic ring or a complex revision, which was hampered by complications, technical complexity, and invasiveness. We described our experience of endoscopic management of this complex problem and the early outcomes. Design: Retrospective study. Setting: Tertiary care center. Patients: Thirteen consecutive patients with gastric outlet obstruction who underwent endoscopic intervention after vertical banded gastroplasty (VBG). Intervention: Endoscopic removal of silastic ring with self-expanding metal stent or endoscopic guided trans-gastric stapled stricturoplasty (TSS). Main Outcome Measurements: Feasibility, safety, and efficacy of endoscopic approaches. Results: Technical and clinical success in 11 patients (85 %) on first endoscopic attempt. Stent migrated in one patient, and another patient required second endoscopic intervention for recurring symptoms. Limitations: Retrospective analysis, single-institution study, and small sample size. Conclusion: Endoscopic approach to gastric outlet obstruction secondary to VBG regardless of type of restrictive device is safe and feasible with possible short-term benefit. This technique may also be use as bridge toward future revision surgery.