Post written by Carlos Paolo Francisco, MD, FPCP, FPSG, FPSDE, from Singapore General Hospital, Singapore, Singapore, and St. Luke’s Medical Center–Global City, Manila, Philippines.

The intragastric balloon (IGB) offers a less-invasive alternative for managing obesity and its associated comorbidities, whether as a primary intervention or a bridge to bariatric surgery. Despite IGB’s potential to address the treatment gap in obesity care, adoption of IGB remains limited because of concerns about adverse events and lack of widespread expertise.

We present a detailed instructional video demonstrating key techniques for simplified IGB placement, removal, and troubleshooting common issues encountered with fluid-filled IGBs.

Steps for IGB insertion:

1. Position the endoscope at 20 to 25 cm in the esophagus.
2. Guide the balloon alongside the endoscope while gently retracting the endoscope until the balloon comes into view.
3. Advance the endoscope and balloon catheter together toward the stomach.
4. Place the balloon in the midbody and insufflate the stomach.
5. Fill the balloon with 650 mL of a combination of saline and methylene blue using the waterjet.
6. Pull the catheter to detach the balloon.

Steps for IGB removal:

1. After securing the airway, position the endoscope near the IGB.
2. Puncture the balloon at the most stable position using an aspiration needle.
3. Insert the catheter deep into the balloon.
4. Suction all the fluid until the balloon is fully deflated.
5. Grasp the balloon with the extraction forceps.
6. Pull the endoscope and forceps together.

IGB is a safe intervention for the treatment of obesity. Adopting the standard insertion and removal technique as described would simplify IGB placement and minimize the risk of adverse events.

Steps for gastric balloon insertion. (A) After a gastric examination, position the endoscope at 20 to 25 cm in the esophagus. (B) Advance the IGB by the side of the endoscope while gently withdrawing the scope. (C) Once the balloon catheter is seen in the esophagus, advance the endoscope and balloon catheter together to the stomach. (D) Place the balloon in the midbody and insufflate the stomach. (E) Using the waterjet function, deliver 650 mL of sterile saline solution and 1% methylene blue combination to expand the balloon. (F) Once expanded, pull the catheter back to release the balloon from the sheath. Confirm position after the balloon release. Maintain the patient on proton pump inhibitors throughout the IGB indwelling time and prescribe antiemetic drugs to manage the accommodative symptoms. IGB, Intragastric balloon.

Read the full article online.

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