Retrieval of intragastric balloon used to treat obesity

Although various other endoscopic bariatric procedures are being developed, the BioEnterics intragastric balloon (BIB) still has the potential to improve quality of life and co-morbidity in nonmorbidly obese patients or in those who are unwilling to undergo bariatric surgery, as recently stated by Tsesmeli & Coumaros in this journal [1]. It should be mentioned that retrieval of the BIB has proved to be a difficult task at times, even though instruments specifically designed for this purpose are available. The difficulty seems to increase in proportion to the length of time that the device has been in the gastric cavity. The manufacturers of the BIB explicitly state: ”The balloon currently can be used for six months. Longer periods of use are not recommended. Over time the acidic content of the stomach will weaken the balloon material …“ [2]. In our practice we have encountered patients who for diverse reasons have come for balloon retrieval after a longer period than recommended. In this group of patients it has been noted, although still only anecdotally, that retrieval has been more difficult than in patients who comply with the 6-month recommendation.

We implanted a BIB in a 43-year-old female patient in April 2009 and she returned for balloon retrieval in March 2010. In this patient, after we had punctured and deflated the balloon we could not retrieve it, as it repeatedly disengaged on reaching the gastroesophageal junction or the pharynx. As we do not have a double-channel endoscope, we passed a snare around the distal end of the endoscope ([Fig. 1]) and introduced both to the stomach; we then grasped the balloon using both the forceps and the snare and successfully retrieved it.

Fig. 1 A snare was passed around the tip of the endoscope before both were introduced into the stomach for retrieval of the BIB balloon. Use of a double-channel gastroscope was not possible.

A significantly lower balloon retrieval time has been found with the technique using a double-channel gastroscope and forceps plus a symmetrical polypectomy retrieval snare [3]; when this method is not available we recommend the procedure described above.

Competing interests: None

References

• 1 Tsesmeli N, Coumaros D. Review of endoscopic devices for weight reduction: old and new balloons and implantable prostheses.  Endoscopy. 2009;  41 1082-1089
• 2 BIB Asia .http://www.bibasia.info/intragastric.html. Accessed 27 May, 2010
• 3 Galloro G, Sivero L, Magno L. New technique for endoscopic removal of intragastric balloon placed for treatment of morbid obesity.  Obes Surg. 2007;  17 658-662