300 Capsule of Consequence: Missed Gastric Band Capsule Leading to Megaoesophagus After Roux-en-Y-Gastric Bypass Surgery: A Video Case Report

Abstract Aim To highlight an important complication of retained gastric band capsule leading to severe dysphagia, food bezoar formation, and aspiration pneumonia in a patient with a history of laparoscopic adjustable gastric banding (LAGB) and subsequent Roux-en-Y gastric bypass (RYGB). Method We present a video case report of the intra-operative findings of a patient who underwent diagnostic laparoscopy for insertion of a feeding gastrostomy. This was necessitated due to multiple emergency admissions with severe dysphagia and aspiration pneumonia in the context of a prior RYGB and historical LAGB removal. Oesophagogastroscopy demonstrated a 10cm food bezoar in the distal oesophagus, and barium swallow demonstrated marked oesophageal dysmotility. Results Following medical stabilisation and total parenteral nutrition, endoscopic and radiological feeding access were deemed unsuitable due to limited anatomical access. Surgical gastrostomy was consequently pursued. Intra-operatively, dense adhesions and a contracted gastric remnant were encountered. Notably, a thickened, fibrotic capsule—remnant from the previous gastric band—was identified unexpectedly at the angle of His. This chronic capsular tissue was dissected and divided, and gastrostomy inserted. The patient remained on TPN for two weeks post-operatively. Post-operative swallowing assessment showed marked improvement, and she was successfully discharged on full oral intake independent of nutritional support with complete symptom resolution. Conclusions This case emphasises the importance of formal capsulotomy during gastric band removal. In patients with a history of gastric banding who present with unexplained dysphagia post-RYGB, retained capsule tissue should be considered. Diagnostic laparoscopy may be warranted, especially when findings are inconclusive on pre-operative endoscopy or imaging.