Trattamento endoscopico di un caso di “gastric outlet syndrome” dopo gastroplastica verticale sec. Mason.

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COD: 129-132 Categorie: ,

Girolamo Geraci, Carmelo Sciumè, Franco Pisello, Francesco Li Volsi, Tiziana Facella, Giuseppe Modica

Ann. Ital. Chir., 2007; 78: 129-132

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INTRODUCTION: Mason’s Vertical Banded Gastroplasty (VBG) is characterized by peculiar complications, related to surgical
pitfalls, from “outlet syndrome” (5%) to complete outlet obstruction (3%), passing to reflux oesophagitis (45%),
that require redo. We report a case of “outlet syndrome” treated by operative endoscopy with success.
MATERIALS AND METHODS: 40 yrs male, operated by VBG 2 years ago for morbid obesity (BMI > 40). After surgery,
initial ponderal decrement as attended. Since about 2 months the patients reports epigastralgia and retrosternal pyrosis;
since 10 days incoercibile vomiting. The EGDS visualized distal oesophagitis (Los Angeles C), mucosal prolapse of superior pouch leading to outlet obstruction
and scalloping of Kerkring’s fold in second part of duodenum.
The patient was submitted to multiple elastic ligature of exuberant gastric mucosa with multiband ligator and indication
to oral therapy with PPI and procinetics drugs at the dismission.
RESULTS: after 30 days, at EGDS, oesophagitis is regressed to Los Angeles B stage, the outlet of pouch is patent and the
transit is objectively regular. At oesophago-gastric radiologic control with gastrographin, the transit was satisfing. At 1
year follow-up the patient has a regular weight, no vomiting and is wellbeing and use irregularly PPI. Follow-up EGDS
confirmed the stabilization of endoscopic picture and the total regression of oesophagitis.
CONCLUSIONS: the endoscopic elastic ligature of mucosal gastric prolapse with multiband after VBG, if confirmed and
validated by randomized and prospective trials on a big sample of people, will constitute a valid alternative to surgical
treatment of this rare complication.

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