Evaluating gastric erosion in band management

An algorithm for stratification of risk

Marina Kurian, Sammy Sultan, Karan Garg, Heekoun Youn, George Fielding, Christine Ren-Fielding

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Laparoscopic gastric banding has several known complications, including gastric erosion. No clear factors have been determined for the development of band erosion, but technical factors such as covering the buckle of the band have been implicated. The objective of the present study was to determine whether band management after surgery, band size, or filling beyond the manufacturer-determined maximal volume has an effect on the incidence of erosion at a university hospital in the United States. Methods: We performed a retrospective review of a prospective institutional review board-approved database. All patients who had been followed from 2002 to 2008 were identified. The maximal band volume was 4 cm 3 for the 9.75-cm/10-cm band and 10 cm 3 for the Vanguard band. The bands were considered overfilled if they had been filled to greater than the maximal volume for ≥3 months. Results: A total of 2437 patients had undergone Lap-Band surgery. Of these 2437 patients, 14 developed erosion (.57%). The primary erosion rate was .39% (9 of 2359). These patients were divided into 3 groups according to the type of band placed: group 1, Vanguard (n = 735); group 2, 9.75-cm/10-cm band (n = 1624); and group 3, revisions to Vanguard, including a band placed around a bypass (n = 78). The incidence of gastric erosion by group was .95% (7 of 735) in group 1, .12% (2 of 1624) in group 2, and 6.41% (5 of 78) in group 3. The difference in the erosion rate among the groups was significant (group 1 versus 2, P = .005; group 3 versus 1, P = .003; and group 3 versus 2, P = .001). Erosions developed in each group without overfilling. Also, comparing the erosion rate in the overfilled versus underfilled bands, statistical significance was found only for group 1 at 3.18% versus .35% (P = .006). The erosion rate in the overfilled versus underfilled was 1.01% versus .07% in group 2 and 11.11% versus 3.92% in group 3. Conclusion: A band that needs to be overfilled might be a sign of erosion, and patients should undergo endoscopy. Band revision has a greater rate of erosion than primary banding. The Vanguard band has a greater risk of erosion than the 4-cm 3 bands.

Original languageEnglish (US)
Pages (from-to)386-389
Number of pages4
JournalSurgery for Obesity and Related Diseases
Volume6
Issue number4
DOIs
StatePublished - Jul 2010
Externally publishedYes

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Keywords

  • Gastric erosion
  • Laparoscopic gastric banding
  • Vanguard band

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Evaluating gastric erosion in band management : An algorithm for stratification of risk. / Kurian, Marina; Sultan, Sammy; Garg, Karan; Youn, Heekoun; Fielding, George; Ren-Fielding, Christine.

In: Surgery for Obesity and Related Diseases, Vol. 6, No. 4, 07.2010, p. 386-389.

Research output: Contribution to journalArticle

Kurian, Marina ; Sultan, Sammy ; Garg, Karan ; Youn, Heekoun ; Fielding, George ; Ren-Fielding, Christine. / Evaluating gastric erosion in band management : An algorithm for stratification of risk. In: Surgery for Obesity and Related Diseases. 2010 ; Vol. 6, No. 4. pp. 386-389.
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abstract = "Background: Laparoscopic gastric banding has several known complications, including gastric erosion. No clear factors have been determined for the development of band erosion, but technical factors such as covering the buckle of the band have been implicated. The objective of the present study was to determine whether band management after surgery, band size, or filling beyond the manufacturer-determined maximal volume has an effect on the incidence of erosion at a university hospital in the United States. Methods: We performed a retrospective review of a prospective institutional review board-approved database. All patients who had been followed from 2002 to 2008 were identified. The maximal band volume was 4 cm 3 for the 9.75-cm/10-cm band and 10 cm 3 for the Vanguard band. The bands were considered overfilled if they had been filled to greater than the maximal volume for ≥3 months. Results: A total of 2437 patients had undergone Lap-Band surgery. Of these 2437 patients, 14 developed erosion (.57{\%}). The primary erosion rate was .39{\%} (9 of 2359). These patients were divided into 3 groups according to the type of band placed: group 1, Vanguard (n = 735); group 2, 9.75-cm/10-cm band (n = 1624); and group 3, revisions to Vanguard, including a band placed around a bypass (n = 78). The incidence of gastric erosion by group was .95{\%} (7 of 735) in group 1, .12{\%} (2 of 1624) in group 2, and 6.41{\%} (5 of 78) in group 3. The difference in the erosion rate among the groups was significant (group 1 versus 2, P = .005; group 3 versus 1, P = .003; and group 3 versus 2, P = .001). Erosions developed in each group without overfilling. Also, comparing the erosion rate in the overfilled versus underfilled bands, statistical significance was found only for group 1 at 3.18{\%} versus .35{\%} (P = .006). The erosion rate in the overfilled versus underfilled was 1.01{\%} versus .07{\%} in group 2 and 11.11{\%} versus 3.92{\%} in group 3. Conclusion: A band that needs to be overfilled might be a sign of erosion, and patients should undergo endoscopy. Band revision has a greater rate of erosion than primary banding. The Vanguard band has a greater risk of erosion than the 4-cm 3 bands.",
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