[Endoscopic treatment of a "gastric outlet syndrome" after Mason Vertical Banded Gastroplasty. Case report].
BACKGROUND
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.


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.
Geraci
Girolamo
G
Università di Palermo - Facoltà di Medicina e Chirurgia, Dipartimento di Chirurgia Generale, d'Urgenza e dei Trapianti d'Organo, Sezione di Chirurgia Generale ad Indirizzo Toracico.
Sciumè
Carmelo
C
Pisello
Franco
F
Volsi
Francesco Li
FL
Facella
Tiziana
T
Modica
Giuseppe
G
D000328:Adult; D017219:Gastric Outlet Obstruction / Q000209:etiology* / Q000628:therapy*; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D013577:Syndrome