Endoscopic Removal of an Eroded LINX® Device Using a Mechanical Biliary Lithotriptor

Background: Magnetic sphincter augmentation (MSA) via the surgical placement of a LINX® device (LINX® Reflux Management System, Torax Medical, Shoreview, MN, USA) is an increasingly performed minimally invasive outpatient anti-reflux procedure with a low erosion rate. The most common initial approach to eroded LINX® devices is endoscopic removal. Often endoscopy centers do not have specialized devices to cut through the newer, more durable LINX® systems. In this paper we describe a unique approach for removal of a LINX® with intraluminal erosion using a commonly stocked mechanical biliary lithotripsy device. Case description: A 63-year-old male with a history of GERD and symptomatic type III paraesophageal hernia (PEH) underwent a robotic PEH repair with magnetic sphincter augmentation (1.5T, 17 bead) at an outside hospital. He developed an acute recurrence of his PEH, and subsequent upper endoscopy and contrast esophagram four weeks postoperatively revealed a gastric erosion of the LINX device, which had migrated 6 cm onto the stomach. Attempted endoscopic LINX® removal using the OVESCO remove DC Cutter device was unsuccessful. Using principles of prior endoscopic bariatric lap band foreign body removal, the entire LINX® device was successfully removed with the described biliary lithotriptor technique. Conclusion: Using a common biliary mechanical lithotriptor device and a guidewire to transect the newer 1.5T LINX® Reflux Management System is a safe, effective and familiar technique for endoscopic removal of an eroded MSA device.

Is gallstone disease a “disease of well-being”?

Gallstone disease (choledocholithiasis) is a pathological condition in which stones are formed in the gallbladder. It is caused by a change in the chemical composition of bile with an increase in the concentration of cholesterol in it, hypomotility of the gallbladder, and a number of metabolic disorders. This disease is widespread throughout the world: according to literary sources, about 10% of the population suffers from it. The lowest prevalence of cholelithiasis is noted in the countries of Africa and Asia, which is associated with dietary habits and the absence of high-calorie foods in the diet. In the structure of the overall morbidity, cholelithiasis ranks third after lesions of the cardiovascular system and diabetes mellitus, and exacerbations of cholelithiasis are one of the main reasons for hospitalization with acute surgical pathology. As a rule, women get sick 3-4 times more often than men. If the conservative treatment is ineffective, surgical intervention is necessary; at the present stage, minimally invasive methods with the use of laparoscopic techniques are becoming increasingly popular. To increase the effectiveness of the endoscopic method of treatment, various methods of contact biliary lithotripsy - laser, mechanical, electrohydraulic [2] - are often used.

Deciding to Buy Expensive Technology: The Case of Biliary Lithotripsy

AbstarctAcquiring expensive, new medical technology requires an evaluation of the efficacy and effectiveness, safety, profitability, feasibility, and risk of a project in the context of the hospital's social responsibility and institutional strategy. A case study of the decision to bring biliary lithotripsy to Strong Memorial Hospital illustrates how these criteria offer managers a coherent approach to difficult and consequential decisions about acquiring medical technology.