Endoscopic argon plasma coagulation of Marlex mesh erosion after vertical-banded gastroplasty

Abstract

Background: Marlex mesh erosions may occur as late complications after vertical-banded gastroplasty. Experience with the endoscopic treatment is limited. Objective: To describe the use of argon plasma coagulation in the endoscopic treatment of eroded Marlex mesh. Design: Case report. Settings: Endoscopy Unit, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. Patients: We describe the endoscopic treatment of eroded Marlex mesh in 2 patients who presented with symptoms of gastric-outlet obstruction. Interventions: In both cases, argon plasma coagulation was used to break down the eroded Marlex mesh. Fragments were subsequently removed with forceps and electrocautery snares. We did not encounter any complications with this method. Results: The endoscopic treatment resulted in lasting symptomatic improvement in both patients. Limitations: Our experience is limited to 2 cases. Conclusions: Argon plasma coagulation appears to be a promising option for the endoscopic treatment of eroded Marlex mesh. It allows the fragmentation of large mesh portions and enables subsequent removal with a snare and a forceps. This method can result in symptomatic improvement and may obviate the need for surgery. Further data are necessary to evaluate the safety and the efficacy of this approach. © 2007 American Society for Gastrointestinal Endoscopy.