Background

Spontaneous hyperinflation of intragastric balloons occurs in <1% causing vomiting,pain and urgent balloon extraction.

Methods

Over 1,900 Spatz3 adjustable balloons were implanted in the Optimal Clinic, Israel from May 2015-April 2019. Mean BMI 35.1; mean weight(wt)214 lbs; mean balloon volume 482 ml(400- 500); 76.7% female. Eight patients(8/1900=0.4%) between months 1 and 3, presented with abdominal pain and vomiting with x-ray revealing an air-fluid level(30% air) in the balloon, consistent with spontaneous hyperinflation. Three treatment methods were utilized: 1) extract the balloon and replace with a new balloon with a smaller volume(-100ml) containing methylene blue, and Rx with oral fluconazole 150 mg X 3 days (NBSM); 2) drain the balloon and refill with a smaller volume(-100ml) containing methylene blue and 5 cc of Nystatin within the balloon(DBSM); and 3) drain the balloon and refill with a larger volume(+100ml) containing 150 mg of fluconazole and 1 gram of ciprofloxacin and without methylene blue (DBL).NBSM:New Balloon,Smaller volume, Meth blue, oral fluconazole.DBSM:Drain Balloon,Smaller volume, Meth blue+nystatinDBL:Drain Balloon,Larger volume,+fluconazole+cipro, and without meth blue

Results

Two patients with NBSM and two patients with DBSM - all four had recurrent spontaneous hyperinflation within 2 weeks, requiring balloon extraction. Four patients that had DBL did not have recurrent hyperinflation and continued for a full 12 month implantation.

Conclusions

1) The numbers are too small and the parameters of treatment are many which preclude any firm conclusions. 2) An in vitro model of spontaneous hyperinflation should be developed. 3) A multi-center prospective study utilizing these or other methods should be done. 4) Until more definitive data is available, for those utilizing an adjustable balloon, method DBL (Drain Balloon,Larger volume,+fluconazole+cipro, and NO methylene blue) looks promising and should be considered- and results should be reported.