S2077 Balloon-Induced Gastric Outlet Obstruction

Abstract

INTRODUCTION: Intragastric balloons (IGB) function as an artificial bezoar and delay gastric emptying by increasing wall strain and contributing to feelings of satiety. 25% of patients who undergo IGB placement will experience complications, with nausea and vomiting as the most common (8.6%), and obstruction within the digestive tract as a much rarer cause (0.8%). Here we report gastric outlet obstruction (GOO) as a rare complication of IGBs. CASE DESCRIPTION/METHODS: A 67-year-old female with hypothyroidism and major depressive disorder presented with 5 days of profound nausea and vomiting. Prior to admission, the patient underwent gastric balloon placement and after the procedure, the patient was unable to tolerate both solid food and liquids. The patient denied any abdominal pain and her last bowel movement was 2 days prior to admission. Lab work revealed severe hypokalemia (2.6 mmol/L) and hypomagnesemia (< 0.2 mg/dL). CT imaging of the abdomen and pelvis revealed an 11-cm gastric balloon within the distal stomach without signs of bowel obstruction (image 1). The patient immediately underwent esophagogastroduodenoscopy, which revealed the IGB obstructing a large food bolus (image 2). The IGB was subsequently deflated and removed. The patient was discharged home after electrolyte repletion and diet toleration. DISCUSSION: Traditionally, the IGB is a silicone balloon filled with saline that is adjustable in size, safe, and significantly effective in weight loss. Almost half of all gastric balloons are removed early. Indications for gastric balloon removal include severe symptom intolerance, balloon deflation, digestive tract obstruction, and concern for gastric ulcer/perforation. Its risks for serious complications should not be overlooked, as digestive tract obstruction from displaced or deflated balloons may lead to gastric perforation or even death. There is debate regarding the preference for type of fluid or air medium in IGBs. The recently implemented air-filled IGB has also been effective in significant weight loss reduction with lower rates of nausea, vomiting and bowel obstruction compared to fluid-filled IGBs. In this case, this was the second fluid-filled IGB the patient had placed and removed. A different type of IGB could have been considered. With new emerging technology in both endoscopic technique and balloon durability, new studies will need to examine the continued safety and efficacy of gastric balloons in obesity management.Figure 1.: Image 1. CT chest with oral contrast, depicting large saline filled gastric balloon.Figure 2.: Image 2. Left: IGB obstructing antrum from prior EGD; Right: IGB obstructing antrum with food bolus.