A First Line of Treatment

Once a popular treatment for obesity and metabolic diseases, laparoscopic adjustable bands—or lap bands—have fallen out of favor due to inferior weight-loss outcomes and increased re-operation rates to treat adverse effects, such as gastric band erosion. Enter endoscopy. First described in 1999, this minimally invasive endoscopic technique allows clinicians to remove eroded gastric bands while avoiding the need for complex, surgical re-operations. Given its benefits, endoscopic interventions have become increasingly utilized over the traditional laparoscopic approach, which is time-consuming and increases risk for postoperative complications. However, no pooled analyses of endoscopic procedures to treat gastric band erosion exist in the literature. That’s why Thomas R. McCarty, MD, MPH, Assistant Professor of Clinical Medicine, published a systematic review and meta-analysis to fill these knowledge gaps.

A total of 282 patients in nine retrospective studies and one prospective study were analyzed. The technical and clinical success of the endoscopic therapy was 86.08% and 85.34%, respectively, with infrequent need to convert to laparoscopic surgery intra-procedure (4.15%) and post-procedure (7.24%). “These results indicate that endoscopic removal of eroded gastric bands is a technically feasible and effective intervention,” McCarty said. “With its high efficacy and low adverse event rate, the research suggests it should be a first line of treatment.” However, this isn’t the case. Lack of endoscopic training, gaps in clinical knowledge, and availability of equipment limits endoscopic interventions from becoming the first line of treatment for gastric band erosion. “Often, this type of procedure is limited to centers of expertise,” McCarty noted. “So, patients would need a referral to these centers for this type of intervention.”

Further research could help propel endoscopic treatment into the new standard management for gastric band erosion. McCarty specifically points to more prospective studies that monitor patients’ postoperative outcomes over time. The study results were not surprising to McCarty. “We've done a fair amount of these endoscopic procedures at Houston Methodist in the last several years, so we know they’re efficacious,” he said. “If we can find minimally invasive treatments that are effective and safe, and patients can avoid a lengthy, more invasive surgery, then these types of interventions are better for the patients overall.”