Letter to the Editor: Experience of Endoscopic Intra-Gastric Balloons Removal During COVID-19 Pandemic in 98 Patients
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LETTER TO THE EDITOR
Letter to the Editor: Experience of Endoscopic Intra-Gastric Balloons Removal During COVID-19 Pandemic in 98 Patients Nesreen Khidir 1
&
Asaad Salama 1 & Moataz Bashah 1,2
Received: 5 September 2020 / Revised: 3 October 2020 / Accepted: 6 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
The novel coronavirus outbreak (2019-nCoV) was declared a Public Health Emergency of International Concern (PHEIC) on 30th January 2020, and a pandemic on 11th March 2020 [1]. International guidelines have been issued, and most elective surgeries were postponed [2]. Additionally, IFSO guidelines recommended postponing the elective Bariatric and Metabolic (B&M) surgeries [3]. Accordingly, all elective bariatric procedures stopped in our center, and the practice became limited to urgent interventions for bariatric complications. Gastrointestinal endoscopy is an aerosol-generating procedure (AGP) with a higher risk of SARS-CoV-2 transmission to both patients and medical staff [4]. Nevertheless, bariatric surgery experts agreed that some endoscopic bariatric procedures are semi-elective/urgent procedures and can be performed following specific protocol during this pandemic [5]. Intragastric balloons had been designed to remain in the stomach for 6 months. Delayed intragastric balloon removal is one of the time-sensitive procedures that carry an increased risk of complications, e.g., migration [6]. Two of our patients with overdue intragastric balloons, encountered migration and both presented to emergency with small bowel obstruction. One required laparoscopic surgical exploration to remove the balloon and the other patient successfully passed the balloon with conservative management. Accordingly, avoidance of further complications mandated to structure a practical algorithm to proceed with the removal of the intragastric balloons during the current COVID-19 pandemic. The proposed algorithm was based on IFSO recommendations for elective surgeries during COVID-19 [5]. It aimed at
* Nesreen Khidir [email protected] 1
Department of Bariatric and Metabolic Surgery, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
2
Weill Cornell Medical College, Doha, Qatar
protecting the patients and the involved healthcare workers. All patients had general anesthesia (GA) and intubation. Although intubation itself is an AGP, GA was preferred. It minimizes coughing, irritation, and aerosolization that accompany sedation during endoscopy. All patients had air-filled balloons for a minimum of 6 months and were due to removal. Only patients with negative COVID-19 RT-PCR swab tests had the procedure. All procedures were performed following the suggested algorithm (see Fig. 1). A retrospective review of all patients who underwent endoscopic removal of intra-gastric balloons during COVID-19 pandemic in a tertiary hospital (29 February 2020–15 June 2020). Study endpoints looked at the complications rate of perforation, bleeding, and pancreatitis, the rate of COVID19 infection in patients aft
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