Interventions – Balloon placement
Balloon insertion was performed after a diagnostic endoscopy in order to detect pathologies that contraindicate balloon placement, such as active peptic ulcer, grade C-D esophagitis, large volume hiatal hernia, esophageal/fundus varices, esophageal strictures and prior gastric surgery.
The endoscopy procedure was realized under deep sedation without endotracheal intubation, with continuous oxygen support of 5L/min and under anesthesiologist supervision. Since there were no impediments, the procedure to implant the balloon was initiated.
In the conventional technique, recommended by the manufacturer, the insertion of the Spatz3® balloon is together with the endoscope (the balloon goes attached to the scope). In the balloon kit, there is a ”condom”, which is connected to the scope tip, and with the condom wrapped, the balloon is placed next to the device. Then the condom takes place over the balloon, attaching it to the device. The assembly (balloon + scope) is then heavily lubricated with appropriate gel and both endoscopic and balloon together are introduced into the patient, gently and parsimoniously. In the gastric cavity, it is recommended to perform the rear view, to confirm that the balloon is fully gastric and have not detached from the endoscope during its introduction, thus avoiding the risk of complications from balloon inflation in the esophagus. The balloon inflation was under direct vision remaining endoscope in rear view. The balloon was inflated with saline (3 %) and with 10 mL of 4% methylene blue. The initial balloon volume was settled at 600 mL.
After the inflation procedure, the filling catheter was pulled-up until the externalization of the balloon valve through the patient’s mouth. At this moment point it is important to introduce the finger through the patient’s mouth placing it over the base of the tongue. The catheter and the valve slide over the finger, protecting the base of the tongue from a possible damage caused by the passage of the valve and avoiding a local bleeding. Then the catheter was disconnected from the valve, which was then covered with a suitable cap with a blue nylon loop on its top. Holding the loop, the valve was gently returned into the patient, releasing it at the oropharynx. So the scope was used to position the valve into the stomach then the balloon was visually inspected to detect possible leaks or valve malfunctions and to confirm the correct position in the gastric fundus. If a leakage was detected a prompt replacement of the defective balloon was conducted.