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Emergency endoscopic removal of intragastric balloon for hematemesis and melena

Epublication WebSurg.com, Feb 2010;10(02). URL: http://websurg.com/doi/vd01en2861

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The BioEnterics® Intragastric Balloon (BIB®) System has been developed as a temporary aid to achieve weight loss in obese people that are 40% or more above their optimal weight, in patients who have had unsatisfactory results in their treatment of morbid obesity despite being cared for by a multidisciplinary team, and in superobese patients for whom surgery is often associated with high risks. The BIB® reduces the volume of the stomach and leads to a premature feeling of satiety. The placement and removal of the BIB® is an interventional endoscopic procedure and the balloon is designed to float freely inside the stomach; its size can be changed during the placement. The technique has absolute contraindications such as voluminous hiatus hernia, abnormalities of the pharynx and esophagus, esophageal varicose veins, use of anti-inflammatory or anti-coagulant drugs, pregnancy and psychiatric disorders. Relative contraindications are esophagitis, ulceration and acute lesions of the gastric mucous membrane. The complications of the BIB® are related to the endoscopic method itself, to sedation and perforation, to its prolonged contact with the mucous membrane and its migration, which may result in esophageal or intestinal obstruction (1). The patients must be clinically supervised during the BIB® placement. Complications and symptoms, such as esophageal injury and vomiting due to BIB® slippage must be described to the patient, along with the possibility that the BIB® may require early endoscopic removal. Since the BIB® works as an artificial bezoar, the patients usually show a maximal reduction in ingestion around the fourth week, and return to normal after 12 weeks. (1) Mathus-Vliegen EMH. Efficacy of bioenterics intragastric balloon treatment in a prospective 2 years follow-up study. Presented at the Eighth European Congress on Obesity; 1997 Aug. Dublin, Ireland: European Congress on Obesity, 1997.