E1140. The Unknown Side of Obesity Treatment: Imaging Findings of Gastric Balloon Complications
  1. Paula Forero ; Fundación Santa Fe de Bogotá
  2. Gustavo Triana ; Fundación Santa Fe de Bogotá
  3. María Veloza ; Fundación Santa Fe de Bogotá
  4. Daniela Carrascal ; Fundación Santa Fe de Bogotá
  5. Silvia Márquez ; Fundación Santa Fe de Bogotá
  6. Manuela Gallo ; Fundación Santa Fe de Bogotá
Since 1982 the use of gastric balloon (GB) has been an alternative for treatment of obesity thanks to its mechanisms in satiety. It is placed by endoscopic procedure and it is relegate to patients with a body mass index (BMI) between 30-40 and that therefore are not candidates for bariatric surgery, also patients who doesn’t want such an aggressive approach or who have any other contraindication for surgical therapy. Although is a safe procedure there is a minor chance of suffering complications that include: gastric ulceration, gastric perforation, deflation with consequent migration and small bowel obstruction, pancreatitis and death. Images play a very important role in the medical assessment of these patients, therefore it is not only important to recognize the normal findings of a correct positioned balloon, but also is extremely relevant to detect the abnormal ones that suggest that a complication is present.

Educational Goals / Teaching Points
To remind the radiologists the importance of reporting the GB when it is observed and of actively looking for potential complications to not overlook them. To illustrate how a GB is normally visualized in modalities such as X-ray, ultrasound and computed tomography (CT). To exemplify the most common complications of GB and how those entities can be seen in studies such as X-ray, ultrasound and CT.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Gastric perforation: Very rare complication secondary to excessive pressure on the gastric wall that produces erosion, ulceration and finally perforation. Images such as CT and plain abdominal x ray are taken in search of radiological signs of free air in the peritoneal space with a distended stomach because of the balloon inside. CT is more sensitive and sometimes can show the exact location of the defect. Migration with bowel obstruction: The gastric balloon can deflate and migrate through out the digestive system initially without any secondary complication. However it has been reported that after certain time it can cause small bowel obstruction, observed as dilated loops and air-fluid levels with out visualization of the normal structure of the gastric balloon. In CT additional findings include the transition zone plus the impacted foreign body deflated (hyperdensity). Sometimes this latter can be recognize in x ray as a radiopaque region. Pancreatitis: It is attributed to patients in whom the other causes of pancreatitis are ruled out and in whom is evidenced in CT compression of the pancreas by the distended balloon. There is also peripancreatic edema (enlargement of the pancreas) and stranding in mild presentations, and peripancreatic fluid collections and necrosis in more severe forms

Identification of GB complications is the combination of recognizing any change in the normal structure or localization of the device along with other findings according to the alteration of the affected organ (pneumoperitoneum, bowel obstruction, inflammation of the pancreas, etc.). Its correct interpretation determines the accuracy of the radiological diagnosis and therefore, the subsequent management of the patient.