Removing foreign bodies in bariatric patient

The ingestion of foreign bodies or food bolus impaction occur at different natural or pathologic levels of narrowing of the esophagus. In bariatric patients, postoperative “strictures” could arise at the level of the gastric body (in sleeve gastrectomy) or the gastrojejunal anastomosis (in Roux-en-Y gastric bypass) or at the level of surgical foreign body insertion: the ring (for vertical banded gastroplasty) and band (for laparoscopic adjustable banding). In these patients, food intolerance is a common complication requiring combination of medical, endoscopic, and surgical management that we review here. We emphasize the role of endoscopic dilation of strictures and the newly described endoscopic techniques for the removal of dysfunctioning ring or band after restrictive surgery, by the use of a temporary self-expandable stent insertion and/or of a wire to initiate band/ring cutting. These methods should be considered as possible means to avoid risks of an additional surgery.