Laparoscopic Guided Trans-Gastric Balloon Deflation: A Novel Technique in the Emergency Retrieval of Intragastric Balloons

Abstract

Introduction: Obesity is a global disease, causing a vast array of metabolic diseases and creating a significant burden on the individuals well being and the health system in general. Endoscopic adjuncts such as the intragastric balloon (IGB) have been developed to assist in weight loss. This device requires endoscopic placement and removal and although rare, can lead to complications during the treatment period. Case presentation: A 27 years old patient with a history of smoking and excessive NSAIDS use presented with a gastric perforation, 6 weeks after placement of an intragastric balloon. She required an endoscopic / laparoscopic assisted balloon deflation and removal as well as laparoscopic abdominal washout, repair of gastric perforation and placement of intraperitoneal drains. Due to the unavailability of the endoscopic balloon deflation catheter, we used a laparoscopically guided transgastric Verres needle to puncture and deflate the balloon during the procedure, combined with endoscopic removal of the balloon through the oral route. Discussion: Intragastric balloons are widely produced by different companies and may require manufacturer specific endoscopic needle tip deflation catheter to deflate the device and a specific endoscopic grasper to retrieve it. Due to its size, caliber and mechanism of action, the Verres needle might be a useful balloon deflation adjunct in case the proper equipment is not available in emergency situations. Conclusion: Patients should be properly selected prior to balloon placement according to the probability of complication development and the benefit of the gastric balloon in comparison to other bariatric modalities. The Verres needle provides an additional tool, which may be used in certain situations to deflate the balloon, such as gastric perforations when the proper endoscopic tools aren't available.