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• W3211295573 abstract "Introduction: Obesity, defined as a BMI > 30, affects around 40% of adults in the United States and has grown in pandemic proportions worldwide. Intragastric balloon (IGB) devices, specifically Orbera, is an FDA approved treatment for obesity. All IGB’s are all placed endoscopically under sedation into the stomach. The removal can be performed under general anesthesia (GA), conscious sedation, or monitored anesthesia care (MAC). We present a unique approach of using MAC with the use of a Procedural Oxygen Mask (POM). POM is a clear mask with self-sealing oral and nasal endoscopy ports plus a capnography sampling port. These POM’s allow for an FiO2 up to 80% and flow rate of 8-10 liters per minute (LPM). In addition, it allows for an end tidal CO2 monitor (EtCO2) showing more accurate reflections of apneic episodes. Case Description/Methods: 45-year-old male with a history of obstructive sleep apnea, hypertension, diabetes, and a previously endoscopically inserted IGB presented to the hospital for removal of the Orbera IGB. The POM was used for pre-oxygenation to be achieved efficiently, propofol was administered for sedation, and EtCO2 was monitored throughout. The endoscope was passed through the pre-created hole of the POM and once the IGB was in front of the scope, the needle was introduced puncturing the balloon to aspirate the saline causing it to deflate. Once the IGB was completely drained, the needle was removed, and an alligator forceps was introduced to grasp the deflated IGB. After adequate grasping of the IGB it was pulled to the very tip of the scope, and then retrieval of the balloon was performed. The duration of the procedure was 8-10 minutes in which a higher level of FiO2 and flow rate was maintained, no desaturations, hypoxia, or apneic episodes were noted. Discussion: Orbera intra-gastric balloons are newly offered minimally invasive solutions for those suffering from obesity. The IGB retrieval varies considerably based on the endoscopist experience. Using conscious sedation with local anesthesia may cause discomfort to the patient, but general anesthesia can be more dangerous during this process causing complications resulting in longer hospital stays, higher costs, and possible death. The use of MAC plus POM for the removal of the balloon provides pre-oxygenation to be achieved efficiently and maintains a higher level of FiO2 and flow rate throughout the procedure as compared to nasal cannulas leading to less complications like: desaturations leading to hypoxia, or apneic episodes.Figure 1.: A) Procedural Oxygen Mask (POM) B) Orbera Intra-gastric balloon." @default.
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• W3211295573 date "2021-10-01" @default.
• W3211295573 modified "2023-09-27" @default.
• W3211295573 title "S3628 Intra-Gastric Balloon Removal, Safety, and Efficiency: An Alternative Approach" @default.
• W3211295573 doi "https://doi.org/10.14309/01.ajg.0000788044.61103.8d" @default.
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