Esophageal laceration after failed endoscopic intragastric ballon retrieval and open approach treatment case report

The intragastric ballon (IGB) is an minimal invasive alternative treatment of weight loss, it has a rate of complications of 2.8-5.5 %. This case highlights the importance of surveillance of the patients to prevent further complications.

We present a case of a 43 years old women with IMC of 31.25 kg/m² and diabetes mellitus background, who underwent to insertion of intragastric ballon, unfortunately the patient lost the follow up with the endoscopy without surveillance and remain with the intragastric ballon for 9 months. The patient started to experience abdominal pain, vomit and oral intolerance so the patient attended to the endoscopist to evaluate the cause of her symptoms. The patient was brought to the endoscopy where the retrieval was not successful. The patient is brought to the emergency room for surgical extraction.

Given the high cost, complication risk and invasiveness of bariatric surgery, intragastric ballon treatment may present a safer and lower cost option for weight reduction. Most of the available IGB are recommended time for gastric ballon removal is 6-12 months, with the appropriate surveillance. In our case it was not possible to endoscopic retrieval due malfunction of the Spatz-3's valve, thickening wall and its partial migration towards the fundus and cardia which causes an esophageal laceration and gastric bleeding.

Mandatory education and accreditation of physicians dealing with bariatric endoscopy and strict supervision of obese individuals throughout the time they have the balloon in their stomachs will eliminate most complications.