The use of the BioEnterics intragastric balloon® is generally considered to be safe and efficacious for short-term weight loss, however complications have been reported. The most commonly reported complications include balloon intolerance requiring early removal, gastric erosions, gastric ulcerations, esophagitis, and early deflation of the device.
We report a case of a esophageal perforation following endoscopic removal of an intragastric balloon. To our knowledge, this is the first case of esophageal perforation associated with intragastric balloon extraction reported in the English literature.
The patient, a 59 year old female with a body mass index of 35, had a placed in Mexico two months previously. She subsequently lost thirty pounds. The patient presented to the emergency department with a five-day history of intermittent, epigastric pain and associated nausea and vomiting. On exam, the patient was in no acute distress and vital signs were within normal parameters. CT scan of the abdomen and pelvis revealed a dilated stomach proximal to the baloon with a retained device and a small passage of contrast to the small bowel, consistent with mechanical gastric outlet obstruction due to the BIB. The diagnosis of gastric outlet obstruction was confirmed by an upper gastrointestinal series.
The gastric balloon was removed with some difficulty when passing it through the upper esophagus. The patient tolerated the procedure well and was advanced to a clear liquid diet once she recovered from intravenous sedation. One day following the procedure, the patient became febrile to 38.5 °C with an associated sore throat. The diagnosis of mediastinitis was confirmed by CT of the neck and chest that revealed pneumomediastinum consistent with microperforation of the esophagus. The patient was placed on bowel rest, started on broad spectrum intravenous antibiotics, and transferred to the surgical intensive care unit (SICU) for monitoring. The patient’s SICU course was unremarkable, and she remained hemodynamically stable with vital signs within normal parameters. On hospital day ten, the course of intravenous antibiotics was completed, and the patient was discharged home on a regular diet. She remained asymptomatic at her two-week follow-up office visit.
In conclusion, BIB may be performed with minimal complications, however serious complications may rarely occur in association with this device. The benefits of this procedure should be weighted against its possible complications. It is essential that general surgeons familiarize themselves with the insertion and removal techniques of this device as well as its possible complications, particularly in light of the fact that many patients may travel abroad to have this procedure performed.
Program Number: P143