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Banded RYGB Ring Slippage Endoscopic Removal with Self-expandable Stents: a Comparative Study Between Metallic and Plastic One

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Abstract

Purpose

Banded Roux-en-Y gastric bypass (RYGB) was a common bariatric procedure in the 2000s, and the ring slippage is one of its late adverse events. Both plastic and metallic stents have been reported as adjunct methods to induce erosion and facilitate endoscopic removal of the ring.

Objective

To compare the safety and effectiveness of self-expanding metallic stents (SEMS) and plastic stents (SEPS) to treat ring slippage.

Materials and Methods

We conducted a retrospective longitudinal study analyzing consecutive patients with ring dysfunction treated with stents plus endoscopic removal.

Results

Ninety patients were enrolled (36 SEMS vs. 54 SEPS). The mean age was 48.56 ± 13.07 and 45.6 ± 12.1 in the SEMS and SEPS groups, respectively. All patients had band slippage, but 24 from SEMS group and 23 from SEPS group had further complications. There were more complications in metallic stent concerning mean absolute number of therapy-related adverse events (1.33 ± 0.48 vs. 1.72 ± 0.5, p > 0.05) and time until erosion (14.9 ± 1.6 vs. 13.8 ± 1.4 days, p > 0.05). Female sex and age > 41 years old correlated with longer time to band erosion and higher incidence of adverse events in SEMS patients. In SEPS group, only female sex was a risk factor for adverse events.

Conclusion

Both procedures were efficient at inducing band erosion with similar safety profiles. Older and female patients are at a higher risk of treatment-related adverse events, especially those receiving SEMS.

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Authors and Affiliations

  1. Beneficencia Portuguesa Hospital, São Jose Do Rio Preto, Brazil

    Luiz Gustavo de Quadros

  2. Faculty of Medicine of ABC, Santo André, Brazil

    Luiz Gustavo de Quadros, Manoel Galvão Neto & Eduardo Grecco

  3. Faculty of Medicine of São José do Rio Preto, FAMERP, São José do Rio Preto, Brazil

    Luiz Gustavo de Quadros & Roberto Luiz Kaiser Junior

  4. Kaiser Clinic, Street XV de Novembro, 3975, Redentora, Sao Jose Do Rio Preto, SP, CEP 15015-110, Brazil

    Luiz Gustavo de Quadros, Daniela Coca Germany Faria, Mikaell Alexandre Gouvêa Faria, Mario Flamini Junior & Roberto Luiz Kaiser Junior

  5. Endovitta Institute, São Paulo, Brazil

    Manoel Galvão Neto & Eduardo Grecco

  6. Center of Gastrointestinal Endoscopy, Surgery and Anatomy Department, Ribeirao Preto Faculty of Medicine, University of Sao Paulo, Ribeirão Preto, Brazil

    Vitor Brunaldi

  7. Faculty of Medicine FACERES, São José Do Rio Preto, Brazil

    Idiberto José Zotarelli Filho

  8. University of Sao Caetano Do Sul, São Caetano do Sul, Brazil

    Eduardo Grecco

  9. Mario Covas Hospital, São Paulo, Brazil

    Sâmara Fernandes Santos Martins

  10. Orlando Health, Orlando, FL, USA

    André Teixeira

  11. Universidade Federal de Pernambuco, Recife, Brazil

    Cinthia Barbosa de Andrade & Alvaro Antonio Bandeira Ferraz

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  1. Luiz Gustavo de Quadros
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Corresponding author

Correspondence to Luiz Gustavo de Quadros.

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Key Points

• Food intolerance can be a long-term complication in cases of banded gastric bypass.

• Endoscopic treatment using stents is safe and effective in cases of ring slippage or food intolerance.

• The use of plastic or metallic self-expanding prostheses was safe and effective to induce band erosion with subsequent endoscopic removal.

• Although stenosis occurred more frequently in metallic stent, regular endoscopic management resolved all cases.

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de Quadros, L.G., Faria, D.C.G., Neto, M.G. et al. Banded RYGB Ring Slippage Endoscopic Removal with Self-expandable Stents: a Comparative Study Between Metallic and Plastic One. OBES SURG 32, 115–122 (2022). https://doi.org/10.1007/s11695-021-05742-x

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  • DOI: https://doi.org/10.1007/s11695-021-05742-x

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