Intragastric balloon implantation is an effective method of management of obesity. Many such medical devices have been approved for use in the US and outside the US. They are the treatment of choice in obese patients who desire noninvasive treatment modality and in those not fit for surgery. They have the advantages of been cheaper, reversible, and safer when compared to bariatric (weight loss) surgeries.
There are also a few reported cases of gastric perforation, dilatation and small intestinal obstruction (Coskun & Bozkurt, 2009).
Although the insertion procedure is easy and generally well tolerated by patients, a few complications can occur. The major complications of the intragastric balloon are gastric ulcers, gastric erosion, and esophagitis, spontaneous deflation of the balloon, gastroesophageal reflux.
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One of the infrequent complications that may arise from the gastric balloon is spontaneous deflation and stomach outlet obstruction or subsequent migration into the small intestine causing obstruction. This may lead to abdominal pain, abdominal swelling, vomiting, and constipation. An abdominal surgery is often required to retrieve the balloon in this condition.
Though the incidence of balloon deflation may be as high as 9%, that of migration is about 1.4% with the incidence of obstruction even lesser (Abu Dayyeh et al., 2015). The risk of balloon deflation and intestinal obstruction is significantly higher when balloons are left in place longer than 6 months (Koutelidakis et al., 2008).
Filling the balloon with methylene blue will change the color of the urine and alert you of a deflated balloon before migration and obstruction will occur. The device such as ReShape duo has the relative advantage over other devices as it has a nearly zero incidence of intestinal obstruction. See the article on ReShape duo Balloon for details.
Related: Side Effects of Gastric Balloon
Another complication is the development of an ulcer in the stomach following balloon placement. It occurs as a result of irritation of the stomach by the balloon or not taking recommended acid reducing medication. The incidence of gastric ulceration is up to 10% (ASMBS). It manifests as a burning epigastric (upper abdominal) pain. The severe form may be accompanied by vomiting of blood.
A sudden abdominal pain after intragastric balloon placement, even several weeks or months later, should raise the suspicion of gastric perforation (Koutelidakis et al., 2008). Though a rare complication, it is a life-threatening one. Irritation of the stomach wall and pressure necrosis has been proposed as the mechanism underlying gastric perforation after balloon placement.
Gastroesophageal reflux with esophagitis
This is the inflammation of the interior of the esophagus. The incidence of severe esophagitis following balloon placement was reported to be 1.5% (Mathus-Vliegen, Alders, Chuttani, & Scherpenisse, 2014). This complication is due to reflux of acidic stomach content into the esophagus with subsequent erosion and inflammation of the internal wall of the esophagus. Affected individuals will have a burning chest pain worse on lying down. This complication can be prevented by adequate intake of acid-reducing medication following balloon placement.
The overall incidence of severe complications following gastric balloon placement is very low and most of the complications can be prevented. The intragastric balloon devices still offer safer and reversible methods of weight reduction when compared to the bariatric surgeries.
- Coskun, H., & Bozkurt, S. (2009). A case of asymptomatic fungal and bacterial colonization of an intragastric balloon. World Journal of Gastroenterology : WJG, 15(45), 5751–5753. http://doi.org/10.3748/wjg.15.5751
- Abu Dayyeh, B. K., Edmundowicz, S. A., Jonnalagadda, S., Kumar, N., Larsen, M., Sullivan, S., Banerjee, S. (2015). Endoscopic bariatric therapies. Gastrointestinal Endoscopy, 81(5), 1073-1086. doi:10.1016/j.gie.2015.02.023
- Yap Kannan, R., & Nutt, M. (2013). Are intra-gastric adjustable balloon system safe? A case series. International Journal of Surgery Case Reports, 4(10), 936-938. doi:10.1016/j.ijscr.2013.07.025
- Koutelidakis, I., Dragoumis, D., Papaziogas, B., Patsas, A., Katsougianopoulos, A., Atmatzidis, S., & Atmatzidis, K. (2008). Gastric Perforation and Death after the Insertion of an Intragastric Balloon. Obesity Surgery, 19(3), 393-396. doi:10.1007/s11695-008-9706-5
- Mathus-Vliegen, E., Alders, P., Chuttani, R., & Scherpenisse, J. (2014). Outcomes of intragastric balloon placements in a private practice setting. Endoscopy, 47(04), 302-307. doi:10.1055/s-0034-1390860