Endoscopic Removal of Endoluminally Migrated Mesh in Patient Undergoing Maclean Vertical Bend Gastroplasty

Text We present the case of a 54 year old woman that has undergone the MacLean technique of vertical band gastroplasty in 2003. Because of abdominal pain, nausea and vomiting, an upper endoscopy in July 2022 showed partially migrated mesh creating an incomplete obstruction. We cut the exposed part of the mesh with pulsed APC (Argon Plasma Coagulation, ERBE FiAPC-Sonde 2200A-7.0-effect/strength) close to the sites of penetration through the gastric wall. The control upper GI series showed the normal passage of the contrast medium with stomach anatomy corresponding to previous bariatric surgery. At 6 month clinical follow-up the patient was asymptomatic. This is the first case treated endoscopically with APC, where we applied the method that is used in tailoring of self-expandable metallic biliary stents.