Background

As endoscopic weight loss procedures, and endoscopic procedures become more common there will be increasing complexity in further or revision metabolic procedures. Patients will need careful endoscopic evaluation preoperatively of their current anatomy. When first presented to the market endoscopic procedures were seen by some patients as fantastic alternatives to traditional surgery especially percutaneous aspiration drainage devices that were approved for patients with a BMI of 35-55 kg/m2. We have a case report of a patient who underwent placement of a percutaneous aspiration drainage device in 2016 who failed to sustain weight loss and requested to be evaluated for further metabolic surgery. She had undergone removal of the percutaneous device because of complications including persistent, uncontrolled drainage that had failed multiple attempts at endoscopic management. She was now ready to pursue further bariatric surgery and presented to the clinic. Upon standard preoperative EGD, she was found to have sutures and fasteners in the anterior proximal antrum. There is a paucity of data currently available in regards to secondary surgery after endoscopic procedures and this case report highlights how variable placement of some endoscopic devices can lead to challenges in further bariatric surgery.