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Background

Patients with a history of vertical banded gastroplasty (VBG) have a long-term complication rate of 30-55%, often related to the band and resultant proximal gastric outlet obstruction (pGOO) Symptoms include reflux, vomiting, and solid intolerance resulting maladaptive eating leading to poor nutrition and weight regain. The purpose of this study is to assess the utility of upper gastrointestinal (UGI) series and esophagoduodenoscopy (EGD) in the evaluation of VBG failures.

Methods

We retrospectively reviewed VBG patients that presented between March 2007 and June 2021. All patients were specifically questioned regarding symptomatology and underwent EGD and UGI during their diagnostic work up.

Results

Patients most often presented with symptoms of reflux (73%), solid intolerance (59%), vomiting (57%), and nausea (36%). On EGD, 52% displayed gastric outlet obstruction or stricture at the band site, 29% had hiatal hernias, 22% had staple line breakdown, 15% had band erosion, 13% had dilation of the pouch. Gastritis and esophagitis were reported at 33% and 19% respectively. On UGI, gastroesophageal reflux (GERD) was in 30% of the patients, while slow transit of contrast and stricture were found only in 25%. Hiatal hernias were reported in 27%, and staple line breakdown 7%.

Conclusions

Although UGI may provide information regarding reflux and anatomical changes to the stomach, it does not correlate well with extent of obstruction at the band site. EGD detected more GOO and gastrograstric fistula compared to UGI, and also serves as a therapeutic intervention should there be an eroded band.