Ransford Commey, MD, Ryan Lehmann, DO, FACS, FASMBS, Norbert Richardson, MD, FACS, FASMBS. St Alexius Hospital
Background: Several endoscopic bariatric therapies have been approved for use in the treatment of obesity and metabolic syndrome. The Orbera Intragastric balloon is one of the first devices to be approved in the United States. It is a single saline-filled balloon (400 – 700 mL) that is endoscopically inserted into the stomach for a period of 6 months. Rare complications of intragastric balloons include hyperinflation, deflation, gastric outlet obstruction, and pancreatitis. Spontaneous hyperinflation with resultant gastric outlet obstruction requires balloon removal.
Methods: We present the case of a 44-year-old female, BMI 37.6, who underwent placement of Orbera Intragastric balloon. She presented 2-1/2 months later with complaints of worsening nausea, vomiting and increasing fullness in the left upper quadrant. A computed tomography scan showed the balloon in position within the stomach but significantly enlarged at 15.6 x 14.2 x 12.4cm with an air-fluid level. The spontaneously hyperinflated balloon was causing a gastric outlet obstruction. She was taken to the operating room and the balloon was endoscopically removed.
Results: The patient lost approximately 40Lbs from time of balloon insertion to removal. During endoscopy, the balloon was visualized in the gastric antrum. It appeared maximally inflated and tense with an air-fluid level. Attempt at the normal aspiration procedure resulted in balloon rupture and spillage of the saline content which was then suctioned. The deflated balloon was removed endoscopically in its entirety. The patient was discharged home the same day.
Conclusion: Spontaneous hyperinflation of the Orbera Intragastric balloon is a possible complication of the procedure. Clinicians must maintain a high index of suspicion in patients who present with symptoms of increasing left upper quadrant fullness and gastric outlet obstruction following balloon insertion. Endoscopic treatment of this complication with balloon removal is feasible and should be carried out following clinical and radiographic diagnosis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93824
Program Number: P180
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster