Eight Minute Technique for Orbera Gastric Balloon Removal

Abstract

Introduction: Orbera is an endoscopically placed intra gastric balloon approved by the FDA for short term weight loss with an average of 31% pounds excess weight loss. Many centers perform removals under general anesthesia with the use of an over tube, making the procedure a longer and more costly one. Methods: A single therapeutic gastroenterologist successfully removed 12 Orbera balloons from June 2016-March 2017 at the ambulatory endoscopy center under propofol sedation only, with the Orbera system removal kit. All patients were placed in a non-rebreathing mask at 100% oxygen in the holding area until sedation was started, when a nasal cannula at 3 Lt/min was placed for the procedure. All patients were instructed to follow a liquid diet for 48 hours prior to the removal date. The needle was marked at 4 cms and 6 cms apart from the tip before passing it through the scope. Once the balloon was in front of the scope, the needle was introduced up to the 6 cms mark. It is very important to keep the needle straight and with no more than 2cms between the balloon and the scope to avoid kinking the catheter. Once the aspiration flow becomes slow the catheter is pulled out until the next mark, this is very important to avoid pulling out the aspiration catheter prematurely before complete deflation. Once the edges of the balloon evidence that a complete deflation was achieved, the grasp forceps from the extraction kit are used. It is critical to place the forceps deep into the more pronounced edge of the balloon and to avoid exposure of the esophagus to the metal, the forceps are pulled to the very tip of the scope before retrieval of the balloon. Results: All 12 balloons were successfully removed in an average scope in to scope out time of 8 minute. There were no complications. All the patients had >95% oxygen saturation for the entire procedure, without the need for general anesthesia. Conclusion: Orbera balloon can be safely and quickly removed by adhering to a protocol of using a non-rebreathing mask pre procedure to avoid hypoxemia in those patients, keeping the puncture catheter within the two marks at 4 and 6 cms apart, to safely move the aspiration catheter without early removal of the catheter before fully deflating the balloon, keeping a straight catheter position with no more than 2 cms between the balloon and the scope and achieving a firm entire grasp of the more pronounced deflated edge and keeping the forceps and balloon at the tip of the scope, pulling until it is out.