Background

Paucity of studies exist regarding the safety and efficacy of endoscopic removal of eroding gastric bands and rings. Additionally, five different techniques have been reported in the literature, without comparative data about their safety and efficacy.

Methods

A literature review was performed in Cochrane Database, Embase, Medline, PubMed, and Scopus electronic databases using terms 'bands', 'rings' and 'endoscopy' to identify pertinent articles. The initial search yielded 572 studies which were manually reviewed. Sixty-eight studies met the inclusion criteria.

Results

A total of 503 cases were included in the analysis. Success rate (defined as complete removal using solely endoscopic approach) was 92%. Failure of endoscopic removal was related to tissue overgrowth (adhesions and fibrosis), technical difficulties, incomplete erosion, and bleeding in 38%, 26%, 18% and 3% of the cases respectively. Gastric-band cutter system, mechanical lithotripsy, pre-removal stenting, simple removal, and laser; were the techniques of choice in 57%, 14%, 14%, 11%, and 4% of cases respectively. Adverse events occurred in 9% of cases, without any major morbidity or mortality. The most common adverse events were pneumoperitoneum, abdominal pain, vomiting, post stent removal strictures, and bleeding. Higher risk of adverse events was noticed with pre-removal stenting technique.

Conclusions

Endoscopic removal of eroded bands and rings is highly successful but associated with 8% risk of failure and 9% risk of adverse events. It is crucial to take into consideration the possible need for salvage laparoscopic intervention to address failures and adverse events at the time of removal.