title: The Gatekeeper™ for fecal incontinence: Another trial and error.
abstract: BACKGROUND
  The Gatekeeper™ is the most recent bulking agent used in the treatment of fecal incontinence with no reported complications. This case reports side effects similar to other bulking agents, namely migration of the prosthesis and perianal abscess.
  
  
  METHODS
  A 52 year old gentleman presented with a history of fecal soiling. He underwent uncomplicated surgery in 2012 for 6 Gatekeeper™ implantations with only temporary improvements. In 2013, endorectal ultrasound revealed prosthesis migration. In 2014, he presented with a perianal abscess which contained one of the prosthesis.
  
  
  CONCLUSIONS
  The Gatekeeper™, made of the inert Hyexpan, typically implanted in the intersphincteric region, has been used for the treatment of fecal incontinence since its discontinuation in the treatment of gastroesophageal reflux disease.(5) The Gatekeeper™ was implemented on a small number of subjects for which the typical side effects of bulking agents were not seen.
  
  
  CONCLUSIONS
  Larger studies need to be conducted to investigate the advantages or perhaps disadvantages of the Gatekeeper™ over other bulking agents.
authors.affiliation: Rashid Hospital, Dubai, United Arab Emirates. Electronic address: lsalozaibi@gmail.com.
authors.forename: Labib
authors.initials: L
authors.lastname: Al-Ozaibi
authors.affiliation: Rashid Hospital, Dubai, United Arab Emirates.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Kazim
authors.affiliation: Rashid Hospital, Dubai, United Arab Emirates.
authors.forename: Wessam
authors.initials: W
authors.lastname: Hazim
authors.affiliation: Rashid Hospital, Dubai, United Arab Emirates.
authors.forename: Alya
authors.initials: A
authors.lastname: Al-Mazroui
authors.affiliation: Rashid Hospital, Dubai, United Arab Emirates.
authors.forename: Faisal
authors.initials: F
authors.lastname: Al-Badri
keywords: Bulking agents; Fecal incontinence; Gatekeeper