A313 INTRAGASTRIC BALLOON REMOVAL: PUNCTURE, DILATE, DEFLATE
Notice bibliographique
Résumé
The growing obesity epidemic has led to the development of a number of endoscopic bariatric weight-loss procedures, including intragastric balloons (IGB). The US FDA-approved IGB devices are the Orbera (Apollo Endosurgery), ReShape (ReShape Medical Inc), and Obalon (Obalon Therapeutics Inc), whilst two other internationally recognized IGB systems are the Spatz (Spatz Medical) and the Elipse (Allurion Technologies). Each device is made of silicone and filled with 0.9% saline solution to a total volume between 400-950cc. As per FDA approval, the IGB should be removed after 6 months. The most common side effects are nausea/vomiting, abdominal pain, and reflux, requiring early IGB removal in up to 9% of patients. Other complications include balloon deflation± migration, gastric ulcers, perforation, and pancreatitis. The mortality rate is 0.05%. Adverse events specific to removal of IGBs include aspiration pneumonia, esophageal tears and perforation. Although IGBs were CDFA-approved in Canada in the early 2000’s, few endoscopists currently practice this procedure. Increasing international use of the IGB combined with the rising incidence of Canadians traveling abroad for bariatric procedures means that Canadian endoscopists will be faced with managing these devices and their complications. We describe the case of a patient who presented with complications due to IGB and detail our endoscopic approach to its safe removal. A 51-year-old male presented 14 months after IGB placement in Saudi Arabia with intractable reflux, nausea and vomitting. The balloon manufacturer was unknown. At ultrasonography, the IGB volume was 550cc. All laboratory investigations were normal. The gastroscopy was performed under general anesthesia with endotracheal intubation. The IGB was identified and no significant complications noted within the stomach or esophagus. After an esophageal overtube was inserted, the wall of the IGB was punctured with an injector needle, but with poor drainage of fluid with aspiration alone. The puncture site allowed introduction of a JAG 0.035 wire into the balloon with subsequent dilatation of the opening by CRE balloon to 15mm and successful evacuation of fluid. Once decompressed, the balloon was grasped via snare and removed through the overtube. Repeat gastroscopy showed unharmed gastric and esophageal mucosa. The IGB was subsequently identified as a non-FDA/CDFA approved Spatz adjustable balloon (Image 1). The increased incidence of endoscopic bariatric interventions means that endoscopists will need to become familiar with management of IGBs and their complications. We recommend that IGBs be removed under general anesthesia using an esophageal overtube for safe extraction by following a “puncture, dilate and deflate” technique as described with an endoscopic assessment of gastric and esophageal mucosa post removal. A) Inital endoscopic appearance B) IGB puncture/dilation C) Deflated IGB D) Extracted IGB CAG, None
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,004 | 0,004 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,005 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».