Endoscopic removal of a magnetic sphincter augmentation device eroded into the esophagus using a mechanical lithotriptor.

BACKGROUND AND AIMS: Device erosion is a rare, serious adverse event of magnetic sphincter augmentation (MSA) device implantation for gastroesophageal reflux disease (GERD), occurring in 0.3% of cases. Limited literature exists regarding endoscopic approaches to device removal, making evidence-based guidance challenging. We describe an endoscopic technique for removal of an eroded MSA device using a mechanical lithotriptor under fluoroscopic guidance. METHODS: Upper endoscopy was used to visualize 2 beads of the MSA device at the gastroesophageal junction. A 0.035-inch, 450-cm guidewire was advanced past the device via balloon catheter and retrieved on the opposite side, forming a loop between 2 beads. A rescue biliary mechanical lithotriptor passed over the wire was torqued to sever the metal link between the beads. The separated device fragments were removed via snare. Fluoroscopy confirmed complete extraction. RESULTS: Postprocedure, the patient experienced self-resolving substernal pain without radiographic evidence of perforation. She was observed overnight and discharged the next day on a staged diet plan without recurrence of symptoms including GERD or dysphagia. CONCLUSIONS: Endoscopic removal of an eroded MSA device using a mechanical lithotriptor is feasible, effective, and safe. This approach broadens the management options for MSA erosion and emphasizes the value of innovation in complex GERD cases.