Journal of Clinical Medicine Article Endoscopic Gastric Band Removal Thierry Manos 1 , Anamaria Nedelcu 2 , Patrick Noel 2,3,4 , Viola Zulian 2 , Marc Danan 2 , Ramon Vilallonga 2,4,5 , Sergio Carandina 2 and Marius Nedelcu 1,2, * 1 ELSAN—Clinique Bouchard, 13000 Marseille, France 2 Centre Chirurgical de l’Obésité, ELSAN—Clinique Saint Michel, 83100 Toulon, France 3 Mediclinic Airport Road Hospital, Abu Dhabi 48481, United Arab Emirates 4 Universitat Autònoma de Barcelona, 08028 Barcelona, Spain 5 Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Hospital Vall d’Hebron, 08023 Barcelona, Spain * Correspondence: nedelcu.marius@gmail.com; Tel.: +33-695-950-965 Abstract: Background: Laparoscopic adjustable gastric band (LAGB) procedures have declined world- wide in recent years. A known complication is the intraluminal erosion of the prosthetic material. The endoscopic management of gastric band erosion represents the recommended approach nowadays, and it avoids any additional trauma to the gastric wall already damaged by the migration. The purpose of our study was to assess the feasibility of endoscopic management for intraluminal gastric band erosion following LAGB. Methods: From January 2009–December 2020, a total of 29 patients were retrospectively reviewed after undergoing endoscopic gastric band removal. The study included all consecutive patients who underwent endoscopic gastric band removal in this period. No patients were excluded from the study. Data on patient demographic characteristics, case history, operative details (procedural time, adverse events), and complications were reviewed retrospectively. Results: Twenty-nine patients underwent endoscopic gastric band removal: 22 women (75.8%) with a mean age of 45 years (range: 28–63) and mean Body Mass Index (BMI) of 31 ± 4.7 kg/m2 (range: 24–41). The average time to the identification of erosion after LAGB was 42 months (range: 28–137). The initial upper endoscopy found a migrated band of more than half of the diameter in 21 cases, less than a half but more than a third in seven cases and in one case, less than a third (use of a stent). Citation: Manos, T.; Nedelcu, A.; Twenty-seven patients were successfully treated with endoscopic removal, and in two cases, the Noel, P.; Zulian, V.; Danan, M.; endoscopic approach failed, and laparoscopy was further performed. Conclusions: The endoscopic Vilallonga, R.; Carandina, S.; management of intraluminal erosion after LAGB can be safe and effective and should be considered Nedelcu, M. Endoscopic Gastric the procedure of choice when treating this complication. The percentage of the band migration is Band Removal. J. Clin. Med. 2023, 12, important for the timing of the endoscopic removal. 617. https://doi.org/10.3390/ jcm12020617 Keywords: laparoscopic adjustable gastric band; complication; migration; endoscopy Academic Editor: David Benaiges Boix Received: 14 November 2022 Revised: 6 January 2023 1. Introduction Accepted: 9 January 2023 Currently, obesity is a chronic disease. It is important for the patient and their health- Published: 12 January 2023 care providers to understand this fact. The surgical treatment for this disease should be considered to be a staged approach. The use of a laparoscopic adjustable gastric band (LAGB) is a less radical procedure compared to the Roux-Y gastric bypass (RYGB) or laparoscopic sleeve gastrectomy (LSG), especially in the past, it has been chosen for the Copyright: © 2023 by the authors. treatment of less extreme morbid obesity [1–3]. Licensee MDPI, Basel, Switzerland. LAGB procedures have declined worldwide in recent years. In most of the national reg- This article is an open access article isters, the numbers of gastric band removals and revisions following LAGB have surpassed distributed under the terms and conditions of the Creative Commons the implants [4]. A known complication was the intraluminal erosion of the prosthetic Attribution (CC BY) license (https:// material. Initially, the perigastric technique was the most frequently used for adjustable creativecommons.org/licenses/by/ gastric procedures [5]. In order to decrease the complication rate, the latter, the band was 4.0/). placed using the pars-flaccid technique [6]. It is often suggested that the retrogastric or the J. Clin. Med. 2023, 12, 617. https://doi.org/10.3390/jcm12020617 https://www.mdpi.com/journal/jcm postoperative complications could be extremely important. The advanc invasive techniques have allowed clinicians to manage gastric band ero cally, providing improved patient outcomes [7]. The endoscopic manag J. Clin. Med. 2023, 12, 617 2 of 7 band erosion represents the recommended approach nowadays, and it a tional trauma to the gastric wall already damaged by the migration. Th important pars flaccidaspect techniqueconsidering theresults would have better highinrate termsofof revisional surgery less slippage and followin less migra- tion than the perigastric technique. It typically occurs many years after placement. The report our ofexperience symptoms as a but erosion are variable regional referral often include center epigastric with thereservoir pain, dysphagia, endoscopic intraluminal infection, or nogastric band restriction erosion despite following aggressive LAGB. band inflation. The management of this complication can obviously be accomplished through surgery, which could be extremely challenging in these cases of migration, and the risk of postoper- 2. Materials and Methods ative complications could be extremely important. The advances in minimally invasive techniques have allowed clinicians to manage gastric band erosion endoscopically, provid- From January 2009 to July 2020, a total of 29 patients were retrospe ing improved patient outcomes [7]. The endoscopic management of gastric band erosion after undergoing represents endoscopic the recommended gastric approach band nowadays, and removal. it avoids anyAll of thetrauma additional procedures to the gastric wall already damaged by the migration. This represents an important aspect by considering a single endoscopist (T.M.) in two private hospitals. The study include the high rate of revisional surgery following LAGB [8]. We report our experi- patients ence as awho underwent regional referral centeran endoscopic with the endoscopicapproach managementfor gastric band of intraluminal gastricremov Noband erosion were patients following LAGB. excluded from the study. The data on the patient demo teristics, caseand 2. Materials history, Methodsoperative details (procedural time and adverse even cationsFrom were reviewed January retrospectively. 2009 to July We collected 2020, a total of 29 patients the following were retrospectively reviewedvariab after undergoing endoscopic gastric band removal. All of the procedures were performed original procedure, time to erosion, symptom presentation, details of the by a single endoscopist (T.M.) in two private hospitals. The study included all consec- dure, utiveand postoperative patients who underwentcomplications. an endoscopic approachAn forinformed consent gastric band removal document in this forperiod. No patients were excluded from the study. The data on the patient demographic all patients, and the study was approved by our institutional ethical c characteristics, case history, operative details (procedural time and adverse events), and Our decisional complications algorithm were reviewed was synthetized, retrospectively. We collected the and it isvariables following shownforinre-Figure porting: original doscopy is alwaysprocedure, time to erosion, performed symptom presentation, to evaluate details of the the percentage of removal band migra procedure, and postoperative complications. An informed consent document is typically hadused migrated more for all patients, andthan halfwas the study of approved its diameter, we proceeded by our institutional directly with e ethical committee. removal.Our If the band decisional has was algorithm migrated less synthetized, andthan 50% inbut it is shown more Figure 1. Anthan uppera third endoscopy is always performed to evaluate the percentage of band migration. If the band upper endoscopy is performed in 3 months. Meanwhile, the band was gr had migrated more than half of its diameter, we proceeded directly with endoscopic band depending on band removal. If the the haspatient’s migrated symptoms. less than 50% but Ifmore the than migration was less than a third, a reevaluation upper endoscopy is performed in 3 months. Meanwhile, the band was gradually inflated band’s diameter, a stent was deployed in order to induce more migratio depending on the patient’s symptoms. If the migration was less than one-third of the endoscopy wasaperformed band’s diameter, afterinone stent was deployed ordermonth to induceto reevaluate more migration, andtheanmigration upper r endoscopy was performed after one month to reevaluate the migration rate. Figure 1. Algorithm for endoscopic gastric band removal. Figure 1. Algorithm for endoscopic gastric band removal. J. Clin. Med. 2023, 12, x FOR PEER REVIEW 3 of 7 J. Clin. Med. 2023, 12, 617 3 of 7 2.1. Technique The connecting tube was sectioned, and the reservoir was removed before the proce- 2.1. Technique dure Theunder local anesthesia connecting tube was orsectioned, during theand endoscopic procedure. the reservoir In our before was removed technique, the the pro- single channel gastroscope (9.9 mm diameter) was used in all the cases. We cedure under local anesthesia or during the endoscopic procedure. In our technique, the first passed a 450 cm biliary guidewire (Boston Scientific Hydra Jagwire ST, Marlborough, single channel gastroscope (9.9 mm diameter) was used in all the cases. We first passed MA, USA) around a 450 cmthe eroded biliary material.(Boston guidewire We passScientific the wire Hydra throughJagwire a gastric ST,band cutter (A.M.I. Marlborough, MA, Gastric USA) Band Cutter; CJ Medical, Haddenham, UK), and tightening the wire through around the eroded material. We pass the wire through a gastric band cutter (A.M.I. Gastric this device cause the wireCJtoMedical, Band Cutter; sever theHaddenham, eroded band UK), material. and We then removed tightening the wirethe band using through either this device acause snare orwire the largetoendoscopic forceps. sever the eroded bandAllmaterial. of the operative We then steps removedare the summarized band using ineither Figurea 2. Theor snare removal of the bandforceps. large endoscopic materialAllwasofconsidered the operativecomplete steps arewhen there wereinno summarized appar- Figure 2. ent missing portions of the band when examined ex vivo. No attempt The removal of the band material was considered complete when there were no apparentwas made to close the resulting missing mucosal portions of thedefect. All of examined band when the procedures were ex vivo. Noperformed attempt was under madegeneral to closeanes- the thesia. resulting mucosal defect. All of the procedures were performed under general anesthesia. Figure 2. Operative Figure 2. Operative technique: technique: (A)—initial (A)—initial aspect; aspect; (B)—passage (B)—passage of the guidewire; of the guidewire; (C)—complete (C)—complete sectioning; (D)—final aspect. sectioning; (D)—final aspect. In In France, France, the therecommendation recommendationfor forbariatric bariatricrevisional revisionalcases casesis is toto proceed proceed with thethe with 2- step approach. 2-step approach.InInthe thecase caseofofcomplication, complication,such suchasasmigration, migration,this thisapproach approach represents represents no no matter matter of of discussions, and it discussions, and it is is delayed delayed to to aa minimum minimum of of 66 months. months. NoNo patients patients underwent underwent the removal of a partially eroded gastric band at at the the time time ofof another another bariatric bariatric procedure. procedure. 2.2. Statistical Analysis The continuous demographic demographic variables variables were were expressed expressedas mean± asmean standard deviation ± standard deviation range; categorical and range; categoricalvariables, variables,asas well well as as complications, complications, were were reported reported as numbers as numbers and and percentages. The continuous outcome variables were generally reported as percentages. The continuous outcome variables were generally reported as mean ± stand- mean ± standard deviation and range. Descriptive statistics (simple counts and mean values) ard deviation and range. Descriptive statistics (simple counts and mean values) were used were used to to report report the complications the complications and adverse and adverse effects. effects. 3. Results 3. Results During the During the study study period, period, 29 29 patients patients underwent underwent endoscopic endoscopic gastric gastric band band removal. removal. There were 22 women (75.8%) and seven men (24.2%), with a median There were 22 women (75.8%) and seven men (24.2%), with a median age of age of 45(range: 45 years years 28–63). The overall mean body mass index (BMI) was 31 ± 4.7 kg/m2 (range:2 24–41), and (range: 28–63). The overall mean body mass index (BMI) was 31 ± 4.7 kg/m (range: 24– the mean preoperative weight was 81.3 ± 18.7 kg (range: 51–125 kg). Twenty-five patients (86.2%) had procedures performed on an outpatient basis. All of the patients have had an J. Clin. Med. 2023, 12, 617 4 of 7 adjustable gastric band. Considering that in our region, there is an important number of patients with the band placed around the esophagus, it is worth mentioning that in all cases, the band was placed around the stomach. The average time to the identification of erosion after LAGB was 42 months (range 28–137 months). Regarding clinical symptomatology, we have identified the following: • Weight regain for 17 patients (58.6%) • Abdominal pain and fever with repeated port infection for nine patients (31%) • Asymptomatic with an incidental finding on yearly upper GI swallow for three patients (10.3%) The operative reports were also reviewed for the technique used for LAGB: perigastric— eight cases and pars flaccida—12 cases. In the rest of the nines cases, the operative report of the primary procedure was not available. The overall mean operative time for endoscopic removal was 31.2 ± 16.4 min (range: 7–83 min). The initial upper endoscopy found a migrated band of more than half of the diameter in 21 cases, less than half but more than a third in seven cases, and in one case, less than a third. In this case, a 12-cm-long/20-mm-diameter stent (Taewoong Medical Co. Ltd., Goyang, Republic of Korea) was deployed for a period of one month. Consecutively the patient had a migration of more than half of the diameter, and the band was removed endoscopically. Twenty-seven patients were successfully treated with endoscopic removal of the prosthetic materials using the gastric band cutter according to our algorithm (Figure 1). In two cases, the endoscopic approach failed, and laparoscopy was further performed. In one case, the band was sectioned by endoscopy, but the band buckle was entrapped in perigastric adherence. In the other case, the band was very rigid and impossible to be sectioned by the endoscopy. In another case, we encountered great difficulty in removing the band sectioned from the stomach at the level of the gastroesophageal junction. The decision taken was to deploy a stent in order to facilitate the removal. The stent was immediately removed after band extraction. Another option would be to continue to section the band. For the rest of the 26 patients, no additional adverse events were recorded during the endoscopy. All of the patients were systematically followed by our multidisciplinary team at 1, 3, and 6 months after the procedure. A number of 18 patients out of 29 (62.1%) have had a revisional bariatric surgery of Roux en Y Gastric Bypass, except two patients who underwent sleeve gastrectomy. 4. Discussion In order to evaluate the long-term results of LAGB, we should take into account only the patients with the band in place. The number of reoperations needed is very high, and the index of gastric band removal is increasing every year. Most reoperations are performed for reasons of weight regain despite intensive attempts of follow-up, but also due to the high rate of complications. The two most common complications are slippage and band erosion. The etiology of band erosion is still debatable. The theories of gastric erosion range from unrecognized gastric injuries during band placement, gastric wall ischemia secondary to a tight band, port and band infection, excessive upper pouch pressure increase subse- quent to improper food intake, and recurrent vomiting [9]. Although the true incidence of erosion is difficult to obtain, the reported rates for this long-term complication are between 1% and 10% [7,10–15]. The rates of migration depend on three factors: 1. The moment of the follow-up when these rates are reported is probably the most important factor, as long-term experiences are reporting higher percentages of gastric migration. 2. The type of the primary procedure banded RYGBP vs. LAGB. 3. The nature of the prosthetic material: polypropylene mesh vs. adjustable or nonad- justable band. J. Clin. Med. 2023, 12, 617 5 of 7 The percentage could be even higher, Himpens et al. [8] concluded that nearly one out of three patients experienced band erosion, and nearly 50% of the patients required the removal of their bands (contributing to a reoperation rate of 60%). In order to identify these long-term complications, the follow-up of the patients with LAGB must include yearly gastrografin swallow. The prevalence of migration increases over time because patients often remain asymptomatic for long periods or even will never become symptomatic. Con- sidering the risk of band migration and according to certain authors, a routine gastroscopy should probably be discussed [16,17]. In our experience, the migration was suspected on upper GI swallow in all but two cases. In one case, the upper endoscopy was performed for severe gastroesophageal reflux symptoms. In the other case, the diagnosis was missed during the first follow-up visits and it was identified by another surgeon during the next visit in the same center. No systematic upper endoscopy is performed in the follow-up of LAGB cases in our department or in our region. A new concept [18–20] of forced erosion involves placing a covered stent across a stenosis created by the partially migrated band. The erosion of the gastric band can be used for patient benefit in this situation. Over the weeks after stent placement, pressure necrosis of the gastric wall between the stent and band results in the forced erosion of the gastric band and allows the subsequent removal at the time of stent retrieval. In our algorithm (Figure 1), this approach is proposed when the migration is less than one-third or if the migration remains less than half after 3 months of reevaluation. In one patient, a stent was used to favorable induce more migration in order to facilitate the endoscopic removal. The endoscopic approach was used successfully in 93.1% of cases, with two cases requiring surgery for band removal. This percentage is acceptable, with a recently published experience by Robinson et al. [21] of 64%, and it could be explained by two major factors: adequate preoperative evaluation with a good index of diagnosis and endoscopic expertise concentrated in high volume centers. Regarding the technical difficulty, we recorded a case when the endoscopic approach was not feasible. The connecting part of the band was entrapped in the gastric wall. The possibility of mucosal dissection was discussed, but the risk of increasing the gastric defect was considered too important. After further discussion with a surgical team, laparoscopic removal was decided. In the other case, the band was very rigid and impossible to be sectioned by the endoscopy. Spann et al. [22] have concluded that the management of LAGB erosion with a purely endoscopic method must not be considered if the band buckle was not visible. In this case, they would consider a hybrid method, combining the endoscopic and laparoscopic approaches. In our experience, a non-migrated band buckle should not be considered a contraindication to the purely endoscopic approach. Two of the major limitations of our study, as for many other studies, are represented by the retrospective methodology of the study and the limited number of cases included. Our case experience of 29 patients could be considered limited, but the largest experience published was reported by Robinson et al. [21], with 22 cases of band migration and only 14 cases with complete endoscopic removal. 5. Conclusions The endoscopic management of intraluminal erosion after LAGB can be safe and effective and should be considered the procedure of choice when treating this complication of adjustable gastric bands. The erosion of the band inside the gastric lumen allows for potential endoscopic removal without free intraabdominal perforation, compared with the surgical approach. It is important to have a certain expertise in advanced therapeutic endoscopy but also to respect an algorithm in order to better evaluate the results of the endoscopic approach. The percentage of band migration is important for the timing of endoscopic removal. Author Contributions: Conceptualization, M.N. and T.M.; methodology, V.Z. and A.N.; data curation, P.N. and M.D.; writing—original draft preparation, S.C.; writing—review and editing, M.N. and R.V. All authors have read and agreed to the published version of the manuscript. J. Clin. Med. 2023, 12, 617 6 of 7 Funding: This research received no external funding. Institutional Review Board Statement: The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) of Clinique Saint Michel, ELSAN. Reference Number: 008-2021. Informed Consent Statement: Informed consent was obtained from all subjects involved in the study. Data Availability Statement: Our data was included in SOFFCO registry that French society of bariatric surgery keeps confidential. Conflicts of Interest: The authors declare no conflict of interest. References 1. Chapman, A.E.; Kiroff, G.; Game, P.; Foster, B.; O’Brien, P.; Ham, J.; Maddern, G.J. Laparoscopic adjustable gastric banding in the treatment of obesity: A systematic literature review. Surgery 2004, 135, 326–351. [CrossRef] [PubMed] 2. Shah, M.; Simha, V.; Garg, E. Review: Long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status. J. Clin. Endocrinol. Metab. 2006, 91, 4223–4231. [CrossRef] [PubMed] 3. Karlsson, J.; Taft, C.; Rydén, A.; Sjöström, L.; Sullivan, M. Ten-year trends in health related quality of life after surgical and conventional treatment for severe obesity: The SOS intervention study. Int. J. Obes. 2007, 31, 1248–1261. [CrossRef] [PubMed] 4. Lazzati, A.; Guy-Lachuer, R.; Delaunay, V.; Szwarcensztein, K.; Azoulay, D. Bariatric surgery trends in France: 2005–2011. Surg. Obes. Relat. Dis. 2014, 10, 328–334. [CrossRef] [PubMed] 5. Favretti, F.; Cadière, G.; Segato, G.; Himpens, J.; De Luca, M.; Busetto, L.; De Marchi, F.; Foletto, M.; Caniato, D.; Lise, M.; et al. Laparoscopic Banding: Selection and Technique in 830 Patients. Obes. Surg. 2002, 12, 385–390. [CrossRef] 6. Thornton, C.M.; Rozen, W.M.; So, D.; Kaplan, E.D.; Wilkinson, S. Reducing Band Slippage in Laparoscopic Adjustable Gastric Banding: The Mesh Plication Pars Flaccida Technique. Obes. Surg. 2009, 19, 1702–1706. [CrossRef] 7. Chisholm, J.; Kitan, N.; Toouli, J.; Kow, L. Gastric Band Erosion in 63 Cases: Endoscopic Removal and Rebanding Evaluated. Obes. Surg. 2011, 21, 1676–1681. [CrossRef] 8. Himpens, J.; Cadière, G.-B.; Bazi, M.M.; Vouche, M.; Cadière, B.B.; Dapri, G. Long-term Outcomes of Laparoscopic Adjustable Gastric Banding. Arch. Surg. 2011, 146, 802–807. [CrossRef] 9. Chousleb, E.; Szomstein, S.; Lomenzo, E.; Higa, G.; Podkameni, D.; Soto, F.; Zundel, N.; Rosenthal, R. Laparoscopic removal of gastric band after early gastric erosion: Case report and review of the literature. Surg. Laparosc. Endosc. Percutan Tech. 2005, 15, 24–27. [CrossRef] 10. Fobi, M.; Lee, H.; Igwe, D.; Felahy, B.; James, E.; Stanczyk, M.; Fobi, N. Band Erosion: Incidence, Etiology, Management and Outcome after Banded Vertical Gastric Bypass. Obes. Surg. 2001, 11, 699–707. [CrossRef] 11. Kohn, G.P.; Hansen, C.A.; Gilhome, R.W.; McHenry, R.C.; Spilias, D.C.; Hensman, C. Laparoscopic management of gastric band erosions: A 10-year series of 49 cases. Surg. Endosc. 2011, 26, 541–545. [CrossRef] [PubMed] 12. Egberts, K.; Brown, W.A.; O’Brien, P.E. Systematic Review of Erosion after Laparoscopic Adjustable Gastric Banding. Obes. Surg. 2011, 21, 1272–1279. [CrossRef] 13. Neto, M.P.G.; Ramos, A.C.; Campos, J.M.; Murakami, A.H.; Falcão, M.; Moura, E.H.; Evangelista, L.F.; Escalona, A.; Zundel, N. Endoscopic removal of eroded adjustable gastric band: Lessons learned after 5 years and 78 cases. Surg. Obes. Relat. Dis. 2010, 6, 423–427. [CrossRef] [PubMed] 14. Cherian, P.T.; Goussous, G.; Ashori, F.; Sigurdsson, A. Band erosion after laparoscopic gastric banding: A retrospective anal-ysis of 865 patients over 5 years. Surg. Endosc. 2010, 24, 2031–2038. [CrossRef] 15. Di Lorenzo, N.; Lorenzo, M.; Furbetta, F.; Favretti, F.; Giardiello, C.; Boschi, S.; Alfredo, G.; Micheletto, G.; Borrelli, V.; Veneziani, A.; et al. Intragastric gastric band migration erosion: An analysis of multicenter expe-rience on 177 patients. Surg. Endosc. 2013, 27, 1151–1157. [CrossRef] 16. Hainaux, B.; Agneessens, E.; Rubesova, E.; Muls, V.; Gaudissart, Q.; Moschopoulos, C.; Cadière, G.B. Intragastric band erosion after laparoscopic adjustable gastric banding for 215 morbid obesity: Imaging characteristics of an underreported complica-tion. AJR Am. J. Roentgenol. 2005, 184, 109–112. [CrossRef] 17. Karmali, S.; Sweeney, J.F.; Yee, K.; Brunicardi, F.C.; Sherman, V. Transgastric endoscopic rendezvous technique for removal of eroded Molina gastric band. Surg. Obes. Relat. Dis. 2008, 4, 559–562. [CrossRef] [PubMed] 18. Wilson, T.D.; Miller, N.; Brown, N.; Snyder, B.E.; Wilson, E.B. Stent induced gastric wall erosion and endoscopic retrieval of non adjustable gastric band: A new technique. Surg. Endosc. 2013, 27, 1617–1621. 19. Dugan, J.; Bajwa, K.; Singhal, S. Endoscopic removal of gastric band by use of a stent induced erosion technique. Gastrointest. Endosc. 2016, 83, 654–655. [CrossRef] 20. Campos, J.M.; Moon, R.C.; Neto, G.E.; Teixeira, A.F.; Jawad, M.A.; Silva, L.B.; Neto, M.G.; Ferraz, Á.A. Endoscopic treatment of food intolerance after a banded gastric bypass: Inducing band erosion for removal using a plastic stent. Endoscopy 2016, 48, 516–520. J. Clin. Med. 2023, 12, 617 7 of 7 21. Robinson, T.J.; Soriano, C.; Larsen, M.; Mallipeddi, M.K.; Hunter, J.A.; Chang, L. Endoscopic removal of eroded laparoscopic adjustable gastric bands: A preferred approach. Surg. Obes. Relat. Dis. 2020, 16, 1030–1034. [CrossRef] [PubMed] 22. Spann, M.D.; Aher, C.V.; English, W.J.; Williams, D.B. Endoscopic management of erosion after banded bariatric procedures. Surg. Obes. Relat. Dis. 2017, 13, 1875–1879. [CrossRef] [PubMed] Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). 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