Presentation Title

It Won't Pop

Format

Poster

Start Date

6-11-2020 2:30 PM

End Date

6-11-2020 2:45 PM

Abstract

A 29 year old female patient presented with abdominal pains for the last 7 days. About 3 weeks ago, she had a procedure done for weight loss. In this procedure, she swallowed a pill that inflated into a balloon in the stomach. She also reported nausea and inability to eat more than a few bites. She has had about 10 pound weight loss since the gastric balloon procedure was done 3 weeks ago. Also, at the time the balloon was placed, she was also checked for helicobacter pylori and it was tested positive. She was treated with amoxicillin, clarithromycin and esomeprazole for 10 days. Eradication for helicobacter pylori had not been checked. She had no surgical history. She denied using any tobacco, alcohol or any drugs. On examination, her vitals were normal. She was alert and oriented and in no acute distress. The physical examination was within normal limits. CT scan of the abdomen with intravenous and oral contrast revealed a large and well circumscribed balloon versus cystic structure measuring 12 x 9 x 9 cm, containing mostly fluid but also a small amount of air was found. It corresponded to the finding on concurrent sonogram. There was no gastric outlet obstruction, or bowel obstruction of any kind. It was decided to keep her NPO and an EGD was scheduled for the next day. Intravenous fluids were started. Surgical consultation was requested. No immediate surgical intervention was recommended by surgical team. EGD revealed normal esophagus, intra-gastric balloon, mild gastritis and normal. Multiple maneuvers were used to deflate the balloon including puncturing with the needle to remove the fluid from the balloon and suctioning the intra-balloon fluid via the needle puncture. Significant amount of watery fluid was removed from the balloon. We tried other techniques like hot snaring, using hot biopsy forceps and cutting with cold biopsy forceps, but the material of the balloon was very slippery and none of these techniques worked. At this point, the balloon was partially deflated as the fluid was oozing out gradually. We grabbed the edge of the partially deflated balloon and attempted pulling it out however there was resistance due to the large size of the balloon. Under direct observation, we applied constant traction on the balloon by pulling it into esophagus against the GE junction and that helped deflate the balloon further into almost completely empty and it was pulled out gradually out of the stomach and esophagus by gentle traction along with the scope under direct visualization. Retrived balloon handed over to the patient's family. The patient was kept in the hospital for monitoring. She reported feeling excellent and that all her abdominal pains and discomfort had resolved completely. Her diarrhea had resolved as well. She was started on GI soft diet which she tolerated well. She was discharged with daily PPI and recommendation to follow up with a gastroenterologist in 1 week for the results of stool HP ag testing for confirming eradication of helicobacter pylori.

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Nov 6th, 2:30 PM Nov 6th, 2:45 PM

It Won't Pop

A 29 year old female patient presented with abdominal pains for the last 7 days. About 3 weeks ago, she had a procedure done for weight loss. In this procedure, she swallowed a pill that inflated into a balloon in the stomach. She also reported nausea and inability to eat more than a few bites. She has had about 10 pound weight loss since the gastric balloon procedure was done 3 weeks ago. Also, at the time the balloon was placed, she was also checked for helicobacter pylori and it was tested positive. She was treated with amoxicillin, clarithromycin and esomeprazole for 10 days. Eradication for helicobacter pylori had not been checked. She had no surgical history. She denied using any tobacco, alcohol or any drugs. On examination, her vitals were normal. She was alert and oriented and in no acute distress. The physical examination was within normal limits. CT scan of the abdomen with intravenous and oral contrast revealed a large and well circumscribed balloon versus cystic structure measuring 12 x 9 x 9 cm, containing mostly fluid but also a small amount of air was found. It corresponded to the finding on concurrent sonogram. There was no gastric outlet obstruction, or bowel obstruction of any kind. It was decided to keep her NPO and an EGD was scheduled for the next day. Intravenous fluids were started. Surgical consultation was requested. No immediate surgical intervention was recommended by surgical team. EGD revealed normal esophagus, intra-gastric balloon, mild gastritis and normal. Multiple maneuvers were used to deflate the balloon including puncturing with the needle to remove the fluid from the balloon and suctioning the intra-balloon fluid via the needle puncture. Significant amount of watery fluid was removed from the balloon. We tried other techniques like hot snaring, using hot biopsy forceps and cutting with cold biopsy forceps, but the material of the balloon was very slippery and none of these techniques worked. At this point, the balloon was partially deflated as the fluid was oozing out gradually. We grabbed the edge of the partially deflated balloon and attempted pulling it out however there was resistance due to the large size of the balloon. Under direct observation, we applied constant traction on the balloon by pulling it into esophagus against the GE junction and that helped deflate the balloon further into almost completely empty and it was pulled out gradually out of the stomach and esophagus by gentle traction along with the scope under direct visualization. Retrived balloon handed over to the patient's family. The patient was kept in the hospital for monitoring. She reported feeling excellent and that all her abdominal pains and discomfort had resolved completely. Her diarrhea had resolved as well. She was started on GI soft diet which she tolerated well. She was discharged with daily PPI and recommendation to follow up with a gastroenterologist in 1 week for the results of stool HP ag testing for confirming eradication of helicobacter pylori.