Premature explantation of an EndoBarrier gastrointestinal liner because of sleeve invagination

 

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The EndoBarrier gastrointestinal liner (GI Dynamics, Lexington, Massachusetts, USA) ([Fig. 1]) is an endoscopically deployed and fully reversible treatment modality for type 2 diabetes and/or obesity [1]. Adverse events related to its use include transient abdominal pain, nausea, and vomiting, which typically occur within the first 2 weeks after implantation. We present the first case of premature explantation of the EndoBarrier after recurrent abdominal pain, nausea, and vomiting due to invagination of the sleeve.

Following implantation, a 25-year-old obese woman experienced recurrent epigastric pain and nausea with occasional vomiting. The severity of the symptoms led to hospitalization 4 weeks after implantation. Abdominal computed tomography revealed no migration or signs of obstruction of the device ([Fig. 2]), and a biochemical profile showed the following elevated values: plasma alanine transaminase, 84 U/L (normal range 10 – 45); aspartate transaminase, 53 U/L (normal range 10 – 35); amylase, 205 U/L (normal range 10 – 65). The white blood cell count remained normal, but the C-reactive protein level fluctuated up to 58 mg/L (normal values < 10). Upper gastrointestinal endoscopy revealed invagination of the device ([Fig. 3]), which was uneventfully explanted. The patient was discharged well and with normalized blood values.

Abdominal pain, nausea, and/or vomiting are common symptoms within the first 2 weeks after implantation [2]. Similar symptoms have been reported in association with device obstruction [3], but also without obstruction [4]. Other adverse events, which may result in abdominal symptoms, include device-related ulceration [5] and device migration. However, the latter have also been reported in asymptomatic patients [4]. Invagination of the EndoBarrier has not previously been reported. Computed tomography may be employed for diagnosis, but upper gastrointestinal endoscopy seems preferable because it allows device explantation, depending on the findings.

Obstruction of the EndoBarrier due to invagination may be the cause of recurrent epigastric pain. Therefore, it should be emphasized that patients experiencing epigastric pain, nausea, and/or vomiting beyond the first 2 weeks should be thoroughly examined with regard to the function and location of the device.

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• References

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