El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Intragastric Balloon for the treatment of Obesity.      Intragastric Globe (air filled).       Most studies were performed using liquid-filled balloons.  Air-filled balloons may increase digestive tolerance, efficacy of a new air-filled intragastric balloon in  nonmorbidly obese patients. It can be used as a minimally  invasive first step treatment for those with moderate to severe obesity.

Intragastric Balloon for the treatment of Obesity.

Intragastric Globe (air filled).

Is a lightweight air-filled intragastric balloon

 Most studies were performed using liquid-filled balloons.
 Air-filled balloons may increase digestive tolerance,
 efficacy of a new air-filled intragastric balloon in
 nonmorbidly obese patients. It can be used as a minimally
 invasive first step treatment for those with moderate to
 severe obesity.

 There are two main indications for using an intragastric
 balloon:

  1. Pre–surgery for weight loss in severely obese
     patients to reduce surgical risk.
  2. Weight loss in obese patients who have significant health risks related to their obesity and who have failed to achieve and maintain weight loss with a supervised weight–control programme. The patient should have a BMI above 30.

 For more endoscopic details download the video clips by
 clicking on the endoscopic images, wait to be downloaded
 complete then press Alt and Enter; thus you can observe
 the video in full screen.
.

Intragastric Balloon for the treatment of Obesity ,  Placement of IGB is carried out in an Endoscopy Suite. Intravenous conscious sedation is administered and the throat is sprayed with local anesthetic. Endoscopic examination of the upper gastrointestinal tract is performed. The scope is then withdrawn. The IGB in its collapsed state is attached to an introducer tube. This ensemble is introduced into the stomach via the mouth. Once it is in the correct position the IGB is inflated with air and the introducer tube detached and removed. The entire procedure takes about 15 or 20 minutes.Patients are carefully monitored during the endoscopic procedure and during recovery until they are fully alert.

Video Endoscopic Sequence 1 of 13.

Intragastric Balloon for the treatment of Obesity

 This procedure is totally ambulatory and does not require
 surgery.

 Placement of IGB is carried out in an Endoscopy Suite.
 Intravenous conscious sedation is administered and the
 throat is sprayed with local anesthetic. Endoscopic
 examination of the upper gastrointestinal tract is
 performed. The scope is then withdrawn. The IGB in its
 collapsed state is attached to an introducer tube. This
 ensemble is introduced into the stomach via the mouth.
 Once it is in the correct position the IGB is inflated with air
 and the introducer tube detached and removed. The entire
 procedure takes about 15 or 20 minutes. Patients are
 carefully monitored during the endoscopic procedure and
 during recovery until they are fully alert.

 Like other weight loss surgeries, the balloon is a tool and
 works best when it is properly, following a low calorie diet.

 

Intragastric balloon: a temporary treatment for obesity.  The upper gastrointestinal tract is visualized immediately prior to insertion of the balloon. The diagnostic endoscopy is performed to define anatomy and to exclude concomitant disease which could preclude the safe and effective use of the device. If the stomach is healthy the balloon is introduced into the stomach

Video Endoscopic Sequence 2 of 13.

Intragastric balloon: a temporary treatment for obesity

 The upper gastrointestinal tract is visualized immediately
 prior to insertion of the balloon. The diagnostic endoscopy
 is performed to define anatomy and to exclude concomitant
 disease which could preclude the safe and effective use of
 the device. If the stomach is healthy the balloon is
 introduced into the stomach.

 Unlike liquid filled balloons the air filled balloon is very
 light weighing less than 30g. It will help to tolerate the
 device much better than traditional liquid filled balloons.

Intragastric balloons are a temporary non-surgical obesity treatment that induces short-term weight loss by partially filling the stomach to achieve satiety and reduce food intake.

Video Endoscopic Sequence 3 of 13.

 Intragastric balloons are a temporary non-surgical obesity
 treatment that induces short-term weight loss by partially
 filling the stomach to achieve satiety and reduce food
 intake.

 Obesity is a chronic metabolic disorder with considerable
 health risks, which can be approved by a sustained modest
 weight loss. This can be achieved by medical treatment
 through behavioral therapy, diet, exercise and
 pharmacotherapy. Surgery is often needed for the severely
 obese. Intragastric balloon treatment stands in between,
 being more drastic than medical treatment but less invasive
 than surgery.

Upper Endoscopy Image Showing The Intragastric Balloon. Candidates for IGB: · Patients with moderate obesity (BMI 30 40) which places them at serious medical risk.  Patients with severe obesity (BMI >40) who are awaiting definitive surgery (isolated gastric bypass or gastric banding). Patients with co morbid conditions which make them high risk for surgery or anesthesia who wish to lose weight.

Video Endoscopic Sequence 4 of 13.

Upper Endoscopy Image Showing The Intragastric Balloon

Candidates for IGB

  • Patients with moderate obesity (BMI 30 40) which places them at serious medical risk.
  • Patients with severe obesity (BMI >40) who are awaiting definitive surgery (isolated gastric bypass or gastric banding)
  • Patients with co morbid conditions which make them high risk for surgery or anesthesia who wish to lose weight.
IGB Therapy. The inflated IGB stays in the stomach for a maximum of 6 months during which time patients are followed carefully by our medical specialists. In rare circumstances the IGB may have to be removed before the end of the six months. This can be done at any time. While the balloon is in the stomach the patient will experience a felling of fullness (satiety). Because the balloon takes up a lot of space in the stomach less space is available for food. This results in smaller meals and the loss of excess weight. During the six months the average weight loss is 35 lbs. (range 12-42 lbs).

Video Endoscopic Sequence 5 of 13.

IGB Therapy

 The inflated IGB stays in the stomach for a maximum of 6
 months during which time patients are followed carefully by
 our medical specialists. In rare circumstances the IGB may
 have to be removed before the end of the six months. This
 can be done at any time. While the balloon is in the
 stomach the patient will experience a felling of fullness
 (satiety). Because the balloon takes up a lot of space in the
 stomach less space is available for food. This results in
 smaller meals and the loss of excess weight. During the six
 months the average weight loss is 35 lbs. (range 12-42 lbs).

 Some patients have lost until 60 lbs.

Is a balloon with a triple shell of air molded silicone and both have polymerized interiors totally biocompatible, that permits a better homogeneity with its thickness. This mechanism reduces to a minimum the possibility of migration. The Gastric Balloon is inflated with air and its maximum weight is between 26 and 28 grams. The life expectancy of the Gastric Balloon is between 6 and 7 months, at which time it has to be removed in the same way it was placed with the help of the gastroscope as an ambulatory procedure.

Video Endoscopic Sequence 6 of 13.

  Endoscopic View of Intragastric Balloon

 Is a balloon with a triple shell of air molded silicone and
 both have polymerized interiors totally biocompatible, that
 permits a better homogeneity with its thickness. This
 mechanism reduces to a minimum the possibility of
 migration. The Gastric Balloon is inflated with air and its
 maximum weight is between 26 and 28 grams. The life
 expectancy of the Gastric Balloon is between 6 and 7
 months, at which time it has to be removed in the same way
 it was placed with the help of the gastroscope as an
 ambulatory procedure.

Positioning was performed, after diagnostic endoscopy, under unconscious sedation. After placement, the balloon was slowly inflated with 840-960 cc of air, which gives the inflated final volume of 650-700 cc of air, as the air is compressed.   The most striking difference is that today the use of liquid filled balloons seems to be on the decline, with many surgeons turning to air filled balloons instead. While this statement can not be supported empirically, discussions among surgeons who implant Intragastric Balloons seems to bear this out, as most list overall patient comfort as the primary reason for their conversion. Other reasons that have been cited include:

Video Endoscopic Sequence 7 of 13.

 Positioning was performed, after diagnostic endoscopy,
 under unconscious sedation. After placement, the balloon
 was slowly inflated with 840-960 cc of air, which gives the
 inflated final volume of 650-700 cc of air, as the air is
 compressed.

 Differences between air filled and liquid filled balloons

 The most striking difference is that today the use of liquid
 filled balloons seems to be on the decline, with many
 endoscopist turning to air filled balloons instead. While this
 statement can not be supported empirically, discussions
 among surgeons who implant Intragastric Balloons seems
 to bear this out, as most list overall patient comfort as the
 primary reason for their conversion. Other reasons that
 have been cited include:

 Problems with leaking in liquid filled Balloons

— With liquid filled Balloons, the uncomfortable feeling of constantly carrying around 650 grams (1.43 pounds) of weight in your stomach, versus the typically 30 gram weight of an air filled Balloon.

— With liquid filled Balloons, the sloshing feeling that happens when rapid physical movements take place.

 Endoscopic Image of Intragastric Balloon. It is important to understand that the IGB  is an aid to weight loss and must be used in conjunction with a prescribed diet and behaviour modification program. Therefore, the amount of weight lose will depend on how closely follow the diet. How long  maintain weight loss will depend on how completely adopt long-term lifestyle changes involving eating behavior and exercise.

Video Endoscopic Sequence 8 of 13.

 Endoscopic Image of Intragastric Balloon

 It is important to understand that the IGB is an aid to
 weight loss and must be used in conjunction with a
 prescribed diet and behaviour modification program.
 Therefore, the amount of weight lose will depend on how
 closely follow the diet. How long maintain weight loss will
 depend on how completely adopt long-term lifestyle
 changes involving eating behavior and exercise.

 

The Intragastric Balloon is indicated for use for up to six months in patients with a BMI from 30 kg/m2 to 40 kg/m2, who have significant obesity-related health risks.  It is also indicated for use in morbidly obese individuals, defined as those having a BMI >40 or a BMI <35 with serious physiological risks, who refuse surgery or who have a high surgical risk due to their excessive weight.  Weight reduction through the use of the intra-gastric balloon may help to reduce surgical risk before bariatric (weight-loss) or other surgery.

Video Endoscopic Sequence 9 of 13.

 The Intragastric Balloon is indicated for use for up to six
 months in patients with a BMI from 30 kg/m2 to 40 kg/m2,
 who have significant obesity-related health risks.

 It is also indicated for use in morbidly obese individuals,
 defined as those having a BMI >40 or a BMI <35 with
 serious physiological risks, who refuse surgery or who have
 a high surgical risk due to their excessive weight.

 Weight reduction through the use of the intra-gastric
 balloon may help to reduce surgical risk before bariatric
 (weight-loss) or other surgery
.

 Endoscopic View of Intragastric Balloon. The intragastric balloon may be useful when obesity is not severe enough to justify bariatric surgery, or when patients refuse surgery.  The intragastric balloon is less invasive than surgery, can be repeated, and is reversible.Consecutive balloons can potentially be placed to extend treatment.The use of a second balloon was followed by significant weight reduction in a period of 6 months.

Video Endoscopic Sequence 10 of 13.

 Endoscopic View of Intragastric Balloon

 The intragastric balloon may be useful when obesity is not
 severe enough to justify bariatric surgery, or when patients
 refuse surgery.

 The intragastric balloon is less invasive than surgery, can
 be repeated, and is reversible. Consecutive balloons can
 potentially be placed to extend treatment. The use of a
 second balloon was followed by significant weight reduction
 in a period of 6 months.

Abdominal pain, nausea, and vomiting are common, particularly in the first week after balloon implantation.  Lifestyle intervention, including a combination of low-calorie diet, behavioural modification,and physical activity, is recommended for weight loss. Anti-obesity drug therapy may be used as an adjunct to lifestyle intervention.

Video Endoscopic Sequence 11 of 13.

Abdominal pain, nausea, and vomiting are common, particularly in the first week after balloon implantation.

 Lifestyle intervention, including a combination of
 low-calorie diet, behavioural modification,and physical
 activity, is recommended for weight loss. Anti-obesity drug
 therapy may be used as an adjunct to lifestyle intervention.

 

Moderate weight loss may be achieved if patients adhere to a weight-reduction program.   Weight  gain can recur when the balloon is removed after six months therefore the patient should be following a diet program.   Obesity appears to lessen life expectancy markedly, especially among younger adults. Obesity increases the risk of premature death from coronary heart disease, stroke, type 2 diabetes, gallbladder disease, and some cancers.

Video Endoscopic Sequence 12 of 13.

 Moderate weight loss may be achieved if patients adhere
 to a weight-reduction program.

 Weight gain can recur when the balloon is removed after
 six months therefore the patient should be following a diet
 program.

 Obesity appears to lessen life expectancy markedly,
 especially among younger adults. Obesity increases the
 risk of premature death from coronary heart disease,
 stroke, type 2 diabetes, gallbladder disease, and some
 cancers.

The balloon is place immediately after the GE junction.    The advantage to this balloon is that it positions itself to the top of the stomach, where there are receptors that give a sensation of being full.

Video Endoscopic Sequence 13 of 13.

The balloon is place immediately after the GE junction.

 The advantage to this balloon is that it positions itself to the
 top of the stomach, where there are receptors that give a
 sensation of being full.

 We have had no complications nether with the placement non with the removal

 

Plain Abdominal Film.  This image shows the space that is occupied by the balloon.

Plain Abdominal Film

This image shows the space that is occupied by the balloon.

Click here to enlarge the image

 

This endoscopic sequence shows the technique to removal this glove, The balloon is safely removed under exact endoscopic control after 6 months,  we advise to be removed no more than 7 months due to a fact that the material that has been manufactured lost consistency because of the gastric acid and become hard. The more time let in placed the more hard to removal.   The Extraction of the Globe must be carried out in the operation room with Endotracheal intubation under general anesthesia.  Endoscopist are sometimes unfamiliar with methods of removing these endoscopically placed gastric balloons Physicians who are skilled in performing gastroscopy for obese patients require additional training before they can perform balloon placement and removal.

Video Endoscopic Sequence 1 of 9.

This endoscopic sequence shows the technique to removal this globe.

 The balloon is safely removed under exact endoscopic
 control after 6 months, we advise to be removed no more
 than 7 months due to a fact that the material that has been
 manufactured lost consistency because of the gastric acid
 and become hard. The more time let in placed the more
 hard to removal. The maximum time a balloon can be left
 in place is 7 months, after which it must be removed

 The Extraction of the Globe must be carried out in the
 operation room with Endotracheal intubation under general
 anesthesia.
Endoscopist are sometimes unfamiliar with
 methods of removing these endoscopically placed gastric
 balloons
Physicians who are skilled in performing
 gastroscopy for obese patients require additional training
 before they can perform balloon placement and removal.

 

A special needle is inserted though the endoscope to deflate the IGB. Once it is fully deflated it is grasped with specially designed forceps and removed via the mouth.  The balloon is punctured using a sharp needle around the device. The needle is then attached to an automatic aspirator which takes 5 minutes to extract all the air out of the balloon before it can be removed.  The extraction must be carry out with the kit of extraction that the manufacturer provides, contains two instruments a flexible sharp needle to extract the air and the other a special grasping forceps.

Video Endoscopic Sequence 2 of 9.

 A special needle is inserted though the endoscope to
 deflate the IGB. Once it is fully deflated it is grasped with
 specially designed forceps and removed via the mouth.

 The balloon is punctured using a sharp needle around the
 device. The needle is then attached to an automatic
 aspirator which takes 5 minutes to extract all the air out of
 the balloon before it can be removed.

 The extraction must be carry out with the kit of extraction
 that the manufacturer provides, contains two instruments a
 flexible sharp needle to extract the air and the other a
 special grasping forceps.

The globe is deflated using a deflation needle which is used to perforate the Intra gastric globe in the stomach and to remove all the air from the globe via aspiration.  In this video clip it observed several perforations and a suction pump is adapted in its end outside of endoscope which will extract all the air.

Video Endoscopic Sequence 3 of 9.

 The globe is deflated using a deflation needle which is used
 to perforate the Intra gastric globe in the stomach and to
 remove all the air from the globe via aspiration.

 In this video clip it observed several perforations and a
 suction pump is adapted in its end outside of endoscope
 which will extract all the air.

The Globe is completely deflated and ready to be removed.

Video Endoscopic Sequence 4 of 9.

The Globe is completely deflated and ready to be removed

Once the globe is completely deflated the extraction technique will be accomplished using a special grasping forceps to extract the Intra gastric  globe from the stomach.

Video Endoscopic Sequence 5 of 9.

 Once the globe is completely deflated the extraction
 technique will be accomplished using a special grasping
 forceps to extract the intragastric globe from the stomach.

 

In order to extract the globe effectively a consistent traction should be maintained while going through the inferior gastro esophageal  sphincter, when  you reach the upper esophageal sphincter you should maintain the same technique until it comes out.

Video Endoscopic Sequence 6 of 9.

 In order to extract the globe effectively a consistent
 traction should be maintained while going through the
 inferior gastro esophageal sphincter, when you reach the
 upper esophageal sphincter you should maintain the same
 technique until it comes out.  

Continuous traction is maintained, we used a dilution of two  buscopax diluted in 250 cc of solution which aid to relax the gastroesophagic sphincter.

Video Endoscopic Sequence 7 of 9.

 Continuous traction is maintained, we used a dilution of
 two buscopax diluted in 250 cc of solution which aid to
 relax the gastroesophagic sphincter.

The balloon is coming out from the mouthguard.

Video Endoscopic Sequence 8 of 9.

The balloon is coming out from the mouthguard

 

Now the balloon is out.

Video Endoscopic Sequence 9 of 9.

Now the balloon is out

Endotracheal Intubation

 The Extraction of the Globe must be carried out in the
 operation room with Endotracheal intubation under general
 anesthesia.

 Download the video clip by clicking on the image.

Video Endoscopic Sequence 1 of 14.

Removal of the Deteriorated balloon

 The air filled balloon that is the one that we used, This
 made up of three layers the external one is of silicone and
 two internal are made of polyurethane, which are quite
 resistant to gastric acids.

 This endoscopic sequence shows the extraction of the
 balloon when this is deteriorated, the balloon is
 recommended to be retired before the 7 months, because
 later the balloon loses force, is deflated, the materials that
 this made are deteriorated and the removal becomes
 more difficult.

 This it is the case of a Salvadoran lady 32 year-old who
 marriage with a Spanish man, this patient emigrated to the
 Spanish republic, in 6 months she had increased 35 pounds
 of weight.
 An intragastric globe was placed, after 7 months returning
 from Spain to the for its extraction, being lost the 35
 pounds that had gained previously, the extraction of the
 balloon was a little difficult since this one was deteriorated
 enough as if there was been within the gastric camera more
 than 10 months, the reason perhaps was that she used in
 the diet of weight loss abundant sherry vinegar in the
 salads.

The present example in this endoscopic sequence it is appraised the extraction of this balloon that is deteriorated and the comparison with previous endoscopic sequence that is almost intact globe that was in 7 months to have implanted. Therefore to avoid the balloon be deteriorated and the procedure be easily removed, it is recommended to retire this balloon before 210 days (7 months). The more time the balloon is in placed the more deteriorated will be, reason why it entails to technical difficulties in its extraction.

Video Endoscopic Sequence 2 of 14.

 The present example in this endoscopic sequence it is
 appraised the extraction of this balloon that is deteriorated
 and the comparison with previous endoscopic sequence
 that is almost intact globe that was in 7 months to have
 implanted. Therefore to avoid the balloon be deteriorated
 and the procedure be easily removed, it is recommended to
 retire this balloon before 210 days (7 months). The more
 time the balloon is in placed the more deteriorated will be,
 reason why it entails to technical difficulties in its
 extraction.

More perforation are being performed with the catheter to extract the air. The balloon being punctured and deflated. Once the balloon is deflated is grasped and removed.

Video Endoscopic Sequence 3 of 14.

 More perforation are being performed with the catheter to
 extract the air. The balloon being punctured and deflated.
 Once the balloon is deflated is grasped and removed.

The completely deflated Globe.

Video Endoscopic Sequence 4 of 14.

The image and the video clip shows completely deflated Globe.

 

 We initiate the extraction with this special instrument, never try to extract it with different forceps because is useless.

Video Endoscopic Sequence 5 of 14.

 We initiate the extraction with this special instrument,
 never try to extract it with different forceps because is
 useless.

 

One of the most important  step,  is to pass the balloon through the cardias, here it is necessary to have something of patience and  the traction has to be maintained.

Video Endoscopic Sequence 6 of 14.

 One of the most important step, is to pass the balloon
 through the cardias, here it is necessary to have something
 of patience and the traction has to be maintained. like
 “Fishing a Fish”

 

In this video clip the balloon is pulled out  towards the upper third.

Video Endoscopic Sequence 7 of 14.

 In this video clip the balloon is pulled out towards the upper third.

 

The Balloon is in the upper third of the esophagus, where some times it is difficult to extract it as in the case presented.

Video Endoscopic Sequence 8 of 14.

 The Balloon is in the upper third of the esophagus, where
 some times it is difficult to extract it, as is in the case
 presented.

The end of the balloon is  in the oropharynx, endotraqueal tube is observed, from the balloon emerges, a red liquid which comes within the balloon, since in some times liquids and rest of foods have been introduced within the globe by osmosis.

Video Endoscopic Sequence 9 of 14.

 The end of the balloon is in the oropharynx, endotraqueal
 tube is observed, from the balloon emerges, a red liquid
 which comes within the balloon, since in some times liquids
 and rest of foods have been introduced within the globe by
 osmosis.

In some times when the balloon is difficult to be removed from the oropharynx, the balloon that is in the tip of the endotraqueal tube could be deflated for a short time but be careful that oropharynx be free of secretion.

Video Endoscopic Sequence 10 of 14.

 In some times when the balloon is difficult to be removed
 from the oropharynx, the balloon that is in the tip of the
 endotraqueal tube could be deflated for a short time but be
 careful that oropharynx be free of secretion.

 

Returning to take it with this grasping.

Video Endoscopic Sequence 11 of 14.

Returning to take it with this grasping.

 

 We continue negotiating with the upper esophagic sphincter.

Video Endoscopic Sequence 12 of 14.

 We continue negotiating with the upper esophagic
 sphincter

 

The Globe goes towards outside.

Video Endoscopic Sequence 13 of 14.

The Globe goes towards outside

 

In the present example of this endoscopic sequence it is appraised the extraction of this balloon that is deteriorated and the comparison with previous sequence that globe is intact. Therefore it is recommends to retire this balloon before 210 days (7 months).

Video Endoscopic Sequence 14 of 14.

The Balloon successful extracted

 In the present example of this endoscopic sequence it is
 appraised the extraction of this balloon that is deteriorated
 and the comparison with previous sequence that globe is
 intact. Therefore it is recommends to retire this balloon
 before 210 days (7 months).

 

To avoids the balloon migration the removal should be before of 7 months of been implanted. This type of balloon is well safe but since we had commented previously does not have to remain in place by more than 7 months, because that globe begin to be deflated and the resistance of the walls will be debilitated by the gastric acids and initiates the risk of migration and it can cause intestinal obstruction.  This is the case of a of 23 year-old lady,  who had been implanted an intragastric balloon for weight lost, she did not show up for appointment of the date of balloon removal, to the 10 months to be implanted, patient who complained of of severe abdominal colic pain and vomiting that are symptom typically of balloon migration to the bowels; the patient was hospitalized, the plain abdominal film showed that the balloon was deflated outside of the stomach, powerful laxatives the same that we used for the preparation of the colon for the colonoscopy (was given (Oral sodium phosphate solution), after 72 hours the balloon had not been expelled that give us the possibility  that this balloon had been stopped in the ileocecal valve where these can cause intestinal obstruction by that we decided to make a special grasping uniting two with weld since these are not made for colonoscope. A colonoscopy was performed the balloon was found at the sigmoides where was easy to manipulate and extract it with a rat grasping.   We have had 4 cases of intragastric balloon migrations, the first   case was  after 11 months to have been placed the patient begun with symptoms, while in the hospital were carefully monitoring with abdominal ultrasound and abdominal radiography, oral sodium phosphate solution was administered  48 hours after initiated with the symptoms the intragastric balloon was expelled by rectum

Migration of Intragastric Balloon

 To avoids the balloon migration the removal should be
 before of 7 months of been implanted. This type of balloon
 is well safe but since we had commented previously does
 not have to remain in place by more than 7 months,
 because that globe begin to be deflated and the resistance
 of the walls will be debilitated by the gastric acid and
 initiates the risk of migration and it can cause intestinal
 obstruction.

 This is the case of a of 23 year-old lady, who had been
 implanted an intragastric balloon for weight lost, she did
 not
show up for the appointment of the date of balloon
 removal, to the 10 months to be implanted, patient who
 complained of of severe abdominal colic pain and vomiting
 that are symptom typically of balloon migration to the
 bowels; the patient was hospitalized, the p
lain abdominal
 film showed that the balloon was deflated outside of the
 stomach, powerful laxatives the same that we used for the
 preparation of the colon for the colonoscopy (was given
 (Oral sodium phosphate solution), after 72 hours the
 balloon had not been expelled that give us the possibility
 that this balloon had been stopped in the ileocecal valve
 where these can cause intestinal obstruction by that we
 decided to make a special grasping uniting two with weld
 since these are not made for colonoscope. A colonoscopy
 was performed the balloon was found at the sigmoids
 where was easy to manipulate and extract it with a rat-tooth
 grasping (foreign body forceps
).

 We have had 4 cases of intragastric balloon migrations,
 the first case was after 11 months to have been placed the
 patient begun with symptoms, while in the hospital were
 carefully monitoring with abdominal ultrasound and
 abdominal radiography, oral sodium phosphate solution
 was administered, 48 hours after initiated with the
 symptoms the intragastric balloon was expelled by rectum

 The second case was this presenting here, the third case
 almost to the year to have been placed, she had not luck to
 expelled by rectum because the balloon was retained in a
 loop of the Ileum due to the patient has multiple bowel
 
postsurgical adhesions formation this patient underwent
 an open laparotomy. The four case after the symptoms
 stated, the balloon was expelled spontaneously in the next
 day.

Intragastric Balloon Migration, Plain Abdominal Film belong of a patient that had the balloon in place for more than 11 months, this intragastric balloon is recommended have to be removed before the end of the 7 months.

Intragastric Balloon Migration

 Plain Abdominal Film belong of a patient that had the
 balloon in place for more than 11 months, this intragastric
 balloon
is recommended have to be removed before the
 end of the 7 months.

 Show that the balloon is deflated in the right iliac fossa

 Most of the our cases (4) of balloon migration have been
 expelled by rectum except one that was retained in a loop
 of the Ileum due to the patient had multiple bowel post
 surgical adhesions.

 

 To see this image enlarged press here.

 A close up of the Balloon Deflated and Migration.

 A close up of the Balloon Deflated and Migration

Migration through the bowels and expelled by rectum

 

 

 

To observe this image enlarged press here.

 

An intragastric balloon is observed which is deteriorated by gastric acid, the black valve is almost intact .

Sequence 1 of 3.

 An intragastric balloon is observed which is deteriorated
 by gastric acid, the black valve is almost intact.

The other side of the balloon, the white valve is observed, the balloon was tear and had left the double layer polyurethane, this globe had remained almost 9 months in the gastric camera, was found in the antrum almost to emigrate.

Sequence 2 of 3.

 The other side of the balloon, the white valve is observed,
 the balloon was tear and had left the double layer
 polyurethane, this globe had remained almost 9 months in
 the gastric camera, was found in the antrum almost to
 emigrate.

 

This balloon was deteriorated, quite soft and easy to manipulate. It was removal only with the foreign-body forceps (rat-tooth) instead of the special designed grasping.

Sequence 3 of 3.

 This balloon was deteriorated, quite soft and easy to
 manipulate. It was removal only with the foreign-body
 forceps (rat-tooth) instead of the special designed grasping.