Lap Band Erosion: Clinical, Radiological and Endoscopic Correlation
Erosion is a long-term complication of lap band surgery, and occurs when the Gastric Band fastened around the upper stomach gradually erodes into the stomach wall and extends into the gastric lumen. Intragastric Lap Band Erosions have been reported at rates that vary from 0.6% to 10% depending of the operative technique, the doctor’s experience, the device used and the most important factor: the patient’s follow up.
The use of NSAIDS, alcohol and smoking have been proposed as three of the main factors contributing to hyperacidity and irritation of the mucosal layer of the stomach. This important layer prevents us from acquiring ulcers in normal conditions. When the irritation is persistent, it can cause erosion of the wall layers of the stomach, which may allow the lap band to migrate into the stomach (”inside out” erosion theory). Repeated vomiting has also been suggested as a possible accelerant, especially when a high degree of obstruction is present (For example, an over-filling of the lap band). Due to the erosion, saliva or food leaks through the hole or ulcer in the stomach and flows along the Lap Band tubing, causing the tissue under the skin of the Lap Band Port to become infected.
In some cases, erosion occurs gradually and may be silent or go unnoticed. However, several clinical symptoms may develop and should raise the suspicion of Lap Band Erosion: (1) cessation of weight loss, (2) weight regain with loss of restriction in the lap band, or (3) a port site infection. The clinical symptoms and radiological or endoscopic findings depend on the degree of erosion.
The diagnosis of Lap Band Erosion can be made at the radiological evaluation performed under fluoroscopy during a band adjustment in both symptomatic and asymptomatic patients. If the radiological evaluation does not show signs of erosion and the patient has the symptoms, the doctor is obligated to perform an endoscopy.
Due to the fact that Lap Band Erosions usually present with a port infection (35%), the infection will continue after removal of the port, especially if erosion is not diagnosed. In these cases of chronic infection, further radiological and endoscopic tests are needed to demonstrate the presence of Lap Band Erosion.
The upper GI does not reveal lap band erosion in its early stages. However, the radiological appearance of late-stage intragastric band erosion on the upper gastrointestinal series is pathognomonic when the “stair sign” is observed. Barium swallow during the upper GI shows a flow of contrast fluid around the portion of the band that has eroded into the stomach. As mentioned before, in cases where the radiological findings are missing, an endoscopic evaluation is mandatory.
Treatment of lap band erosion requires removing the band by laparoscopy or by endoscopy. Weight regain typically occurs following this procedure. However, it is necessary to remove the band in order to avoid further complications. It is recommended to treat Lap Band Erosions with another bariatric procedure 6 to 8 months after a de-banding procedure (Lap Band removal). This is due to the high incidence of complications and failures when the procedure is done immediately following removal, or sooner than 6 months since after removal, since the portion of stomach that has been eroded is weak and prone to leaking.
It is true that Lap Band Migration means the failure of the operation and leads to a second bariatric procedure; however, erosion is considered a complication with a benign course if it is managed properly.
Susana González M.D.