Tripurari Mishra, MD1, Ibrahim Al-Saidi, MD1, Peter Rantis, MD2, Rami Lutfi3. 1Advocate Illinois Masonic Hospital, 2Presence Saint Joseph Hospital, 3Mercy Hospital and Medical Center
Intragastric balloon (IGB) has become an increasingly popular emerging bariatric procedure since the approval of first device in 2015. It is commonly recommended for obese patients with BMI 30-40 who do not qualify or do not chose to have bariatric surgery. While these are non-surgical endoscopic relatively safe procedures, many adverse events have been reported, though rare. This video reports one post op complications and one technical complication.
The first video shows hyperdistention of balloon in a 50 year old obese female with BMI of 33.8, weighing 185. The patient had an uncomplicated placement of balloon and lost 30lbs. On 3rd month follow up, she reported dysphagia which worsened to nausea and food intolerance. She had been started on appetite suppressant 2 weeks prior to visit which was thought to be the cause and was stopped with no resolution of the symptoms. Repeat abdominal exam showed a palpable mass within the abdomen. Abdominal X-rays showed a hyper-distended balloon with air-fluid level. The patient was taken to Endo-suite for removal of the balloon. The procedure was uncomplicated and patient had complete resolution of symptoms after the procedure. IGB fluid was sent for culture which was negative for any growth. There have been 3 previously documented case of IGB hyperdistention attributed to flying, hyperthermia and “nocturnal oxygen supply” (1). All these were air-inflated balloon that are mostly discontinued. Today with saline filled balloon, this complication is thought to be from gas forming bacteria. Although to our knowledge, no organism has been isolated.
Second case involved a 45 year old female with BMI of 32.5, weighing 190lbs presented for IGB placement. The balloon placement was uneventful and patient had 34lb weight loss after 6 months. Removal was done at 6 months under general anesthesia and the balloon was grabbed with rat-tooth grasper but balloon tore at UES despite jaw lift and balloon dislodged. The video shows value of intubation at the time of removal to protect the airway for such unusual circumstances. Video illustrates the challenge of laryngoscope and value of glidoscope for better exposure to safely grab and remove balloon from a critical spot. The patient was extubated after the procedure and did well post operatively.
References:
1) Mathus-Vliegan EMH, Tytgat GNT. lntragastric balloons for morbid obesity: results, patient tolerance and balloon life span. Br J Surg. 1990; 77(1): 76-79.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78847
Program Number: V024
Presentation Session: Thursday Exhibit Hall Video Presentations Session 1 (Non CME)
Presentation Type: EHVideo
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