Virginia Commonwealth University Health System Richmond, VA, United States
Jesse Xie, MD, Milan Patel, MD, Gretchen Aquilina, MD, Matthew Kaspar, MD Virginia Commonwealth University Health System, Richmond, VA
Introduction: In 2018, the prevalence of obesity in adults was estimated to be over 42%. Numerous methods have been proposed to combat this epidemic including lifestyle modifications and counseling, pharmacologic therapy (GLP-1 agonist, antidepressants), and bariatric surgery with varying degrees of success. Endoscopic approaches for weight loss have gain popularity as a less invasive alternative to surgery; intragastric balloons (IGB) received Food and Drug Administration (FDA) approval in 2015. The Spatz balloon has an attached catheter to allow for balloon volume modification, making it the only adjustable IGB (a-IGB) on the market. It currently does not have FDA approval and only available in select countries. Previously literature have demonstrated complications from this particular a-IGB. Here we present a novel case of gastric outlet obstruction (GOO) caused by the newest model despite revisions to previous designs.
Case Description/Methods: 41-year-old female with no significant medical history (BMI 25.8) who underwent endoscopic placement of a-IGB while on vacation in Mexico. Following placement, patient began having nausea, vomiting, and inability to tolerate diet. She presented to a local hospital after one week of symptoms, CT of abdomen was concerning for GOO and patient was transferred to our hospital. Esophagogastroduodenoscopy (EGD) was performed, IGB was found in the antrum with tip of balloon catheter in second portion of duodenum. Catheter was secured with forceps and retrieved to mouth where 500cc of methylene blue solution was extracted by syringe. Snare was then secured around catheter, scope was advanced into stomach, and balloon was retrieved. Patient did well post-procedurally and discharged home the next day.
Discussion: The prevalence of obesity in adults has trended up from an estimated 30.5% in 2000 to 42.4% in 2018, placing a heavy national economic burden on healthcare costs. IGB placement has emerged as an attractive intervention, however it has also been associated with nausea. vomiting, pain, ulcers, Mallory-Weiss tear, pancreatitis, GOO, and perforation. The Spatz ballon is the only volume adjustable IGB on the market but not FDA approved for use in the US. Its balloon anchor has been noted to be especially susceptible to intestinal entrapment, requiring surgical intervention. This is the first case of GOO despite catheter redesign, indicating that risk of migration persists even with balloon anchor removal.
Disclosures: Jesse Xie indicated no relevant financial relationships. Milan Patel indicated no relevant financial relationships. Gretchen Aquilina indicated no relevant financial relationships. Matthew Kaspar indicated no relevant financial relationships.
Jesse Xie, MD, Milan Patel, MD, Gretchen Aquilina, MD, Matthew Kaspar, MD. P0870 - A Novel Case of Gastric Outlet Obstruction From Spatz 3 Adjustable Intragastric Balloon, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.