A Combined Laparoscopic and Endoscopic Approach for an Early Gastric Perforation Secondary to Intragastric Balloon: Endo
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LETTER TO THE EDITOR
A Combined Laparoscopic and Endoscopic Approach for an Early Gastric Perforation Secondary to Intragastric Balloon: Endoscopic and Surgical Skills with Literature Review Riccardo Caruso 1 & Emilio Vicente 1 & Yolanda Quijano 1 & Hipolito Duran 1 & Eduardo Diaz 1 & Isabel Fabra 1 & Luis Malave 1 & Roberta Isernia 1 & Angelo D’Ovidio 1 & Ruben Agresott 1 & Gontrand Lopez-Nava 2 & Benedetto Ielpo 1 & Valentina Ferri 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
In the last decade, the prevalence of obesity has increased tremendously in Europe [1]. Both surgical and endoscopic options have been proven to be effective in treating obesity [2]. Among endoscopic therapies, intragastric balloon (IGB) has been widely used to treat obese patients not meeting or refusing bariatric surgery. It acts mainly by inducing early satiety and delaying gastric emptying [2]. However, despite its several benefits, few complications are associated with IGB [3]. These include gastrointestinal ulceration, distal migration, intestinal obstruction, gastric perforation (GP), haemorrhage and occult gastric bleeding [4]. GP is a rare complication of IGB insertion affecting around 0.1% of patients in the wider series published [4]. GP can
occur either early after balloon insertion or at few weeks or months after placement [5]. We report a case of gastric perforation related to IGB that occurred within the first few days after balloon placement and was managed successfully by a combined endoscopic and laparoscopic approach. A 47-year-old female with class III obesity (BMI 42 kg/m2) underwent IGB insertion. She did not have any obesity-related comorbidities or was taking long-term medications. The endoscopic evaluation of the stomach was normal, and there were no contraindications for IGB insertion. A fluid-filled IGB (650 ml of saline) was deployed in the stomach. She presented 3 days later with fever, abdominal pain and vomiting. Abdominal examination
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04727-6) contains supplementary material, which is available to authorized users. * Riccardo Caruso [email protected]
Angelo D’Ovidio [email protected] Ruben Agresott [email protected]
Emilio Vicente [email protected] Yolanda Quijano [email protected]
Gontrand Lopez-Nava [email protected]
Hipolito Duran [email protected]
Benedetto Ielpo [email protected]
Eduardo Diaz [email protected]
Valentina Ferri [email protected]
Isabel Fabra [email protected] Luis Malave [email protected] Roberta Isernia [email protected]
1
General Surgery Department, Sanchinarro University Hospital, San Pablo University, CEU, C/Oña n° 10., 28050 Madrid, Spain
2
Bariatric Endoscopic Department, Sanchinarro University Hospital, San Pablo University, CEU, Madrid, Spain
OBES SURG
revealed tenderness and peritonitis. Laboratory evaluations showed leucocytosis and elevated C-reactive protein.
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