WHAT ARE THE SYMPTOMS OF BAND EROSION AND ESOPHAGEAL DILATATION?

HAS ANYONE EXPERIENCED BAND EROSION OR ESOPHAGEAL DILATATION? WHAT ARE THE SYMPTOMS?

Hi, Julia -  Erosions and slips (a pouch dilation is a type of slip****ur in about 3-7% of bandsters. So , yes, a fair number of people have them, sadly. almost all are prevented by good bandster habits - following the rules pretty well, avoiding barfing, and definitely avoiding too tight fills. (getting them relieved  promptly)
Some pouch or esophagus dilations  can be corrected with a total unfill and rest period. With  too-tight fill, either the pouch or the esophagus an dilate. An esoph. dliation is more serious, and requires a longer unfill - usually several months. Some do not heal and require band removal.

Re dilations:   they occur after we have had a too-tight fill and have not gotten some out, but tried to live with it, thinking mistakenly that we would lose better. they can occur if we eat more than the limit of 1-1.5 cups of food, even if we 'can" eat more.  the pouch or esophagus dilates to compensate.   With a diliation, we can have some new reflux, find we can eat more and more, can eat things we could not before. Same symtoms as possibly just needing more fill. Some feel a persistent lump in the throat, or a fullness in the bottom of the thoat after eating - this is the esophagus dilating into the throat. When drinking liquid, some cdan feel it back up into the bottom of thr throat. Diagnosed only by fluoro.

Re erosions : here is one of my teaching modules on  erosions:

What is a BAND EROSION ?
An erosion is the most serious of the routine band problems, and
always requires band removal.

the term "BAND EROSION" , like the term "band slip" , is misleading.
The band does not erode - it is nearly indestructible. It is the stomach
tissue that erodes, until the band actually works it's way thru the
stomach wall and part of it the band is INSIDE the stomach.

It sounds like an emergency, but it rarely is. Erosions occur slowly,
over months, from one of the common problems leading to erosions,
and are only very rarely dramatic.

There are rarely any big symptoms, as it is such a gradual process.
As the band slowly eats it's way thru the stomach wall, the tissues
usually seal themselves around the band and close up any hole.

Occasionally, though, the erosion prduces an unsealed hole in the stomach wall that allows stomach acid and stomach contents to leak into the abdominal
cavity. This can cause severe pain, high fever, and a life-threatening
peritionitis.

Sadly, some Bandsters have died from erosion-caused
peritonitis or the surgery to remove the band and repair the stomach.
Removing a band can be very tough, as there is a lot of scar tissue to
get thru and remove. It's much more difficlut htan the original band
placement surgery, more painful, and requres a ger recovery time.

How often does this happen? the slip and erosion rate is now 3-7%,
per the last American Bariatric Society meetings/reports in 2007, and
is increasing over earlier stats. Erosions are the lower end of this
range, with slips much more common.

What causes erosions? 

These are the things felt to play a part:

1. Inexact band placement.
2. too tight fills
3. excessive barfing
4. NSAID use is felt to posibly play a role, as it weakens the
stomach wall ,
causes ulcers, harms the protective stomach mucous, and makes the
stomach less able to resist band pressure.  (Controversial)

5. Banding someone with certain known GI problems, or with some of
the auto-immune problems. These people may have a higher risk of an
erosion, and should consult several experienced surgeons before
deciding they wish to take the ossibly-increased risk of getting
banded. Just because one doc or another will DO the surgery, this
does not mean it is necessarily wise or safe to do it.

5. some erosions occur for no known reason - they are just not well-
understood

6. At the recent Seattle Bash, one of the experienced, and up-to-
date Band surgeons felt that placing more than 1 suture into the
diaphragm
increases erosion risk. Some docs place 2-3 sutures. I have seen no
studies on this yet, but some of other docs agreed.

What are the symptoms?

1. After a period of good restriction and loss, and more and more
fill, there is a sudden total loss of all restriction . THis is
becuase the
band has eaten thru the stomach wall, and more and more fill does
nothing at all, since the band is no longer on the outside of the
stomach, cpmpressing it. It's important to know that sudden loss of
restrciton can also be from othe, simpler causes.

2. Rarely, it is a real emergency, with severe pain, high fever,
peritonitis.

3. generally, no big symptoms at all.

How are erosions diagnosed?

1. symptoms may be suspicious and a barium swallow is done. This
provides other clues.
2. an endoscopy is the test that shows for sure. a thin tube with a
tiny camera on it is placed down the throat and into the stomach.
Then, the band can actually be seen coming thru the stomach wall and
partially inside the stomach.

What can be done?

1. the band always must be removed and the stomach wall repaired. a
few surgeons will replace a new band after 6 months of healing time,
but the rate of a second erosion is much higher.

How can i decrease my risk of suffering an erosion ?

1. choose only a highly-experienced band surgeon who will place the
band precisely. Any surgeon who has done more than a few hundred
bands is considered very experienced by Inamed, the LapBand
manufacturer.

2. IMO, choose for banding now, to get the newest AP bands , designed
specifically to
lower erosion risk, as well as lower risks of slips and other
problems. They are also felt to improve weight loss, per the
literature.

3. avoid too tight fills ! very important!! this means knowing the
definition of a good fill, and getting an overfill removed quickly.
Even if a fill "looks ok" on a fluoro, or the surgeon thinks it is a
good amount, it stiltur out to be an overfill. YOU are responsible
for knowing
what a good fill is, and never keeping one that is too tight.

4. Avoid vomiting  ! very important!! every vomit  risks a slip right
then, and increases risks for future slips and erosions.

With too-tight fills and barfing, the band rubs back and forth on
the stomach and wears the tissue away, allowing the band to eat thru
the stomach wall. This is another major reason we just MUST NOT be
barfing often. To me, more than 1-2x a month is just begging for
trouble. Learn and follow the rules, and eat mindfully, to avoid
barfing.

5. Take part in local and online teaching/support forums, to keep
learning more and more about care and safety of your medical implant.
New things are learned and becoming understood abiut the band and
obesity all the time, new improved bands
being designed and released, and you should know of new developments.
I try to keep up and share new reports and articles here often.

As with ALL band problems, PREVENTION is the key. It's much easier
and wiser to learn how to prevent problems, than to try to pick up
pieces when problems have already occurred.

c. Sandy r, BSN, MN
Band educator

First time posting (ever!)  I was banded 08/06 and had been doin great.  Had lost 86 lbs but have recently gained about 14 back.  Approx a month ago I lost all restriction and could eat anything and everything.  Called my Dr. and went in  a few days later and expressed my concerns.  He was not worried and added fluid.  Still no restriction so I called and went back in less than a week later and again voiced my concerns -slipped band, erosion, SOMETHING?!?  He is still not very concerned and did another fill yesterday.  Still no restriction and I'm getting VERY concerned.  I expected him to do an xray or something.  I am also having severe heartburn again (I hadn't had that since being banded) which I also told him about and he recommended "StomaphX" I am so worried that something is seriously wrong with my band and am getting frustrated and depressed over the weight gain.  I have had to have fluid taken out on 2 occasions but have always taken care of an overfill promptly.  To make matters worse I was a self pay (and am still paying) and currently do not have any health insurance.  Any advice would be appreciated.  Also my Dr has never done any type of xray, fluoroscope or anything. Thanks

Hi  welcome! I'm really sorry your first post is about trouble..  I'd urge you to  insist on a fluoro. Sudden  loss of restriction is worrisome,  I'm afraid. The severe heartburn along with it makes it even more worrisome. You need a VERY prompt fluoro, from a highly-experienced band doc.  I also urge people to get a fluro maybe every 6 months or so, during the "fill and lose " phase. they pick up all kinds of small problems before they become big problems, requiring big fixes. I personally do not feel a fluoro with every fill is wise or needed - they dont tell enough to justify frequent use, since they are radiation, and NO radiation is entirely safe.   Stomaphyx is not meant for bandters, especially when you don't even know what is wrong. yet.  yikes.  Please let us know how you;re doing. in the meantime, what are you doing for the severe, dangerous reflux? Email me privately if you need help, please. sandy r [email protected]

   Definitely one of the most knowledgeable contributors

 

 I personally think Sandy is one of the most knowledgable bandsters I have ever seen posting on OH, please take her advice! Your symptoms sound eerily like mine when my band eroded. I would INSIST on an endoscopy, even if you must pay for it. They did several fluoros on me and took ever view of me imaginable and were not able to see the erosion until they did the endoscopy.... good luck

Hello, everyone!  I am not sure why I  received this post thread from OH, as it has been years since I was involved in band issues or Band education.

I will take this chance, though, to say HI! to all of my old friends who may remember me.

I have been one of the lucky ones. I was banded in March 2003, and remain at goal weight (BMI 22) for more than 11 years, and my Band is fine. (With the exception of one year when I regained 10# with no fill while I was caring for my mother with Alzheimer's. That weight came off when I decided to put myself first) )

I rarely have any trouble. However, let me tell you that KUDU is not  a band-friendly meat! My fiance and I spent 6 weeks in Africa last summer, and Kudu is frequently served. It is tough, stringy, dry, and one bite almost made me barf. 

The Band, sadly, did not live up to it's expectations for a great many people. We had such high hopes...

I know many who lost their Bands, and many who have turned to other procedures. I wish them all well. Still, the requirements for ALL procedures are basically the same: We must change our lifestyles and comply with eating and drinking limitations. 

I am getting married in October, after living together for several years. Jim is a retired University Biology/Environmental Sciences Professor, and we share a love of hiking, photography, travel, and much more. We just bought a wonderful home on the Coast, and will move  next month. 

I am not involved in Band education AT ALL any longer, and have not kept up to date on Band or WLS issues. Please don't email me questions or concerns, as I cannot reply.

The very best to all of you - 

Sandy

You received notification because someone posted on this very old thread from 2008 and it bumped it up to the top of the page, I imagine. 

 

Thanks

I have an appointment Wednesday and am pretty nervous.  Since I am a self pay would an edoscopy be better to have done than the flouro?  What other symptoms did you have?