A novel method for removal of a partially deflated intragastric balloon by Amrit Kamboj. My study co-authors included Dr. Andrew Storm and Dr. Nayanthara Koyeloprabhu. These are our disclosures. A 55-year-old woman presented with abdominal pain and blue-colored urine. Further questioning revealed intragastric balloon placement about 16 months prior to presentation. Abdominal x-rays showed linear gaseous lucencies projecting over the stomach. CT abdomen illustrated ruptured gastric balloon sitting within the cardia and body of the stomach without bowel perforation or obstruction. The patient was intubated and an EGD was performed. Upon entering the stomach, a partially decompressed but intact balloon was found. This made puncture with traditional drainage tools fairly challenging. Disposable endoscopic scissors were then inserted. The endoscopic scissors were used to open the silicone balloon wall to permit complete drainage. This required making a series of additional cuts along the trajectory of the initial cut to fully open the balloon. While much of the fluid had been removed from the balloon in the preceding steps, any remaining fluid in the balloon was gently suctioned as demonstrated here. Balloon removal has been associated with the complication of esophageal perforation even after complete endoscopic evacuation of the balloon, thus making complete removal of the contents in this case, while challenging, absolutely necessary. An endoscopic retractor was inserted and used to grasp the proximal end of the balloon once it was deflated. The balloon was then pulled with gentle traction and removed from the oropharynx in one piece. CO2 encephalation is used to expand the esophagus as the device is retrieved. Here is the balloon that was removed in one piece. Post balloon removal endoscopic examination showed no remaining balloon fragments in the stomach. There were no complications associated with the procedure. A ruptured gastric balloon requires urgent removal to prevent downstream migration which risks obstruction. Endoscopic removal of gastric balloons is typically performed using a needle and catheter to puncture the balloon, suction liquid, and deflate the balloon. However, this process may not be feasible when the balloon is already ruptured. We describe a novel technique to remove a partially ruptured gastric balloon using endoscopic scissors and retractor. This technique may be considered if removal of an intragastric balloon is challenging even after complete evacuation in cases of severe esophagitis or stenosis which can be seen due to reflux while the balloon is dwelling in the stomach for long periods of time. Conclusion Endoscopic removal of a ruptured and partially deflated gastric balloon appears safe and feasible using a combination of endoscopic scissors and retractor. This technique may be considered for cases where either transoral removal or complete drainage of the balloon is challenging.

intragastric balloon removal

novel technique

abdominal pain

endoscopic scissors

complete drainage