Endoscopic management of intragastric balloon related gastric outlet obstruction: A case report and review of literature

BACKGROUND Obesity remains a significant global health concern, and intragastric balloons (IGBs) offer a minimally invasive weight loss option for patients who fail lifestyle and pharmacotherapy interventions. IGBs can cause complications ranging from mild symptoms to severe issues like gastric outlet obstruction (GOO). This report discusses a 39-year-old woman who presented with clinical and radiological features of GOO post Silimed IGB placement. CASE SUMMARY A 39-year-old woman presented to our institution with two-week history of abdominal pain, nausea and vomiting post prandially. This was in the context of a Silimed IGB placement two weeks prior to presentation for weight loss in the context of obesity. A computed tomography of the abdomen demonstrated the IGB device in the body and prepyloric region, with proximal dilatation of the body and fundus of the stomach which contained gastric contents. Due to concerns for GOO, the IGB was removed endoscopically with subsequent symptom alleviation. In addition to this, we performed a literature search of cases of IGB related GOO using the PubMed and Web of Science databases from inception date to the August 26, 2024. A total of 27 articles were included in the analysis, identifying 29 cases of IGB-related GOO. These patients commonly presented with nausea, vomiting and abdominal pain, with symptom onset varying from 3 days to 18 months post IGB insertion. Abdominal computed tomography was the primary diagnostic tool and endoscopic removal was the standard treatment modality. CONCLUSION This is the first reported case of GOO caused by Silimed IGB. While effective for weight reduction, IGB-related GOO is a rare but serious complication, usually requiring endoscopic retrieval. Future research should aim to identify patient factors linked to this complication to enhance clinical-decision making and outcomes.