S5227 Endoscopic Reversal of Vertical Banded Gastroplasty

Introduction: Endoscopic interventions to reverse bariatric surgeries are promising because they offer the advantage of avoiding a surgical operation. Herein, we report the endoscopic reversal of a vertical banded gastroplasty (VBG) in a patient who suffered chronic reflux and recurrent emesis due to outlet obstruction from the surgical band and chronic retention within a dilated gastric pouch. Following the endoscopic reversal of the VBG, the patient reported immediate resolution of his symptoms and a much better quality of life. Case Description: A 57-year-old man underwent an open vertical banded gastroplasty in 1989 for obesity but was unsuccessful at sustaining a reduced body weight. In 2018 he was referred for consultation regarding bothersome reflux symptoms despite lifestyle interventions and acid suppression therapy. Following several attempts to resolve his symptoms by dilating the band to 15 mm, he was referred for an opinion regarding what endoscopic interventions could be performed to permanently reverse the VBG. An endoscopic intervention was proposed to divide the gastroplasty staple line using endoscopic electrosurgical dissection. During the first of 2 proposed procedures, a total of 3 lumen apposing self-expanding metal stents (LAMS) were inserted under endosonographic guidance across the gastroplasty staple line. This step was performed to delineate the correct plane for subsequent dissection, which was then performed 2 months later, and involved the removal of the stents and electrocautery-assisted dissection between the sites where the stents had been placed. Discussion: This case demonstrates an endoscopic method for reversing a VBG. Both procedures were performed entirely on an outpatient basis. The patient recovered quickly and experienced a rapid improvement in symptoms. The development of this technique holds promise for an effective non-operative solution to reversing poorly tolerated VBGs.