S375 A Novel Method for Removal of a Partially Deflated Intragastric Balloon

Abstract

Introduction: Intragastric balloons are being increasingly utilized for weight loss. A ruptured gastric balloon requires urgent removal to prevent downstream migration which risks obstruction. Endoscopic removal of gastric balloons is typically performed using a needle and catheter to puncture the balloon, suction liquid, and deflate the balloon. However, this process may not be feasible when the balloon is already ruptured. Here, we describe a novel technique to remove a partially ruptured gastric balloon. Case Description/Methods: A 55-year-old woman presented with abdominal pain and blue colored urine. Further questioning revealed intragastric balloon placement about 16 months prior to presentation. Abdomen x-ray showed linear gaseous lucencies projecting over the stomach. Computed tomography abdomen illustrated ruptured gastric balloon sitting within the cardia and body of the stomach without bowel perforation or obstruction. The patient was intubated and an esophagogastroduodenoscopy was performed. Due to the partially decompressed balloon, puncture with traditional drainage tools was challenging. Instead, disposable endoscopic scissors were used to cut open the silicone balloon wall to permit complete drainage. An endoscopic retractor was used to grasp the proximal end of the balloon once it was deflated, and the balloon was pulled and removed from the oropharynx in one piece. Post balloon removal endoscopic examination showed no remaining balloon fragments in the stomach. Discussion: We describe a novel technique to remove a partially ruptured gastric balloon using endoscopic scissors and retractor. This technique may also be considered if removal of an intragastric balloon is challenging even after complete evacuation in cases of severe esophagitis or stenosis which be seen due to reflux while the balloon is dwelling in the stomach for long periods of time. Endoscopic removal of a ruptured and partially deflated gastric balloon appears safe and feasible using a combination of endoscopic scissors and retractor. Watch the video at https://tinyurl.com/ACGAbstractS375