Complete endoscopic removal of eroded links. These are the authors. These are our disclosures. A 58-year-old woman was referred for recurrence of heartburn, dysphagia, and unintentional weight loss. She underwent LYNX procedure for gastroesophageal reflux disease and repair of hiatal hernia approximately one year ago. She had recurrence of her reflux symptoms shortly after the procedure and new onset dysphagia that failed to improve through conservative management. A follow-up esavagram was performed and demonstrated the LYNX device at the gastroesophageal junction oriented along 2 and 8 o'clock with a moderate hiatal hernia and moderate stasis of the barium column within the lower esophagus. The treatment options were discussed with a multidisciplinary team and the patient. Surgical revision was deferred due to high surgical risk and thus the decision was made to proceed with an endoscopic dissection of the LYNX device. A 4-centimeter hiatal hernia was visualized along with a partially eroded LYNX device. The LYNX device can be seen here with two visible magnets. An antiverted view shows the eroded LYNX in the stomach cardia. The location of the LYNX can also be visualized on a fluoroscopic image. The first step involved using a double-channel gastroscope with a cap to carefully dissect and mobilize the LYNX device. This was done until enough magnets from the LYNX device were exposed. Here we can see that 50% of the magnets can be visualized. The second step involved utilizing DC current through the novel Ovesco retrieval system to cut the wire holding the magnets in place. After the wire holding the magnets was cut, the LYNX device was carefully retrieved using therapeutic forceps. Complete removal of the LYNX device was confirmed both endoscopically and by fluoroscopy. An antivertebrate view showed the previous location of the eroded LINX device, now removed. A fluoroscopy image done after the procedure shows complete extraction of the LINX device. Contrast was then injected to assess for any evidence or leak or perforation post device removal. To further open up the area in the cardia where the device has migrated, a TTS dilator was passed through the scope. Dilation with an 18, 19, and 20 mm balloon dilator was performed to 20 mm under fluoroscopic guidance. After discharge, the patient reported improvement and consequent resolution of her symptoms. Complete endoscopic removal of an eroded and migrated LYNX device was successfully performed without any procedural complications and improved symptoms. Treatment often requires a concomitant surgical intervention and thus complete endoscopic removal provides a less invasive alternative. The Novoavesco DC Current Retrieval System successfully aided complete endoscopic removal of the eroded LYNX device. This video demonstrates that an endoscopic removal of the eroded LYNX is safe and plausible in patients with high surgical risks. The Novoavesco DC Current Retrieval System can also be successfully utilized in this procedure.

LYNX procedure

gastroesophageal reflux disease

hiatal hernia repair

endoscopic removal

symptom improvement