EXPLANT OF INTRAGASTRIC BALLOON WITH SEVERE FUNGAL COLONIZATION: HOW DO I DO IT?

Introduction:

Placement of a intragastric balloon (IGB) by endoscopic route is an efficient, safe and minimal invasive procedure for the treatment of obesity. Fungal colonization of IGBs is a rare adverse event that can lead to serious complications during IGB removal. The technique described herein may facilitate extraction in these cases and reduce the risk of complications, as this is a safe option for balloon removal after intense fungal colonization.

Case report:

A 43-year-old female patient with a body mass index of 30.7 kg/m², without comorbidities, who was submitted to IGB placement to treat obesity. In the six months following the procedure, the patient was treated with proton pump inhibitors and she lost about 18 kg. Near the date scheduled to remove the IGB, the patient began with persistent fever and myalgia. The complete blood count showed leukopenia (2.0 × 10⁹/L) and thrombocytopenia (48 × 10⁹/L) and her serology (IgM) was positive for Dengue fever. Conservative treatment was instituted with rest and hydration and the patient had a good evolution. The removal of the IGB was postponed until normalization of the platelet count and resolution of the infection (seven months after the IGB placement). Upper endoscopy identified intense colonization of the balloon by fungus. The IGB was emptied according to the conventional technique using a balloon removal needle with the contents being aspirated completely. However, removal of the IGB using endoscopic tweezers was unsuccessful; it was impossible for the IGB to pass through the cardia as it was rigid with rough walls due to the fungal colonization and because of its friability. It was then decided to cut the balloon in the middle using bariatric scissors in order to reduce its thickness and facilitate its extraction. Finally, the endoscopic tweezers were again introduced and the IGB was successfully removed without further complications.