A case of asymptomatic fungal and bacterial colonization ofan intragastric balloon

Abstract

Intragastric balloon therapy, as a part of a multidisciplinary weight management program, is an effective short-term intervention for weight loss. Although the insertion procedure is easy and generally well tolerated by patients, a few complications can occur. We report here a heavy smoker with intragastric balloon insertion complicated by colonization with opportunistic organisms. The 27-year-old female, body mass index 35.5 kg/m 2 , had a BioEnterics ® Intragastric Balloon inserted under conscious sedation without any perioperative complications. Six months later, when the standard removal time arrived, the balloon was seen to be covered with a necrotic white-gray material. Microbiological examination revealed Enterobacter cloacae and Candida species yeast colonies. We recommend that asymptomatic fungal and/or bacterial colonization should be considered among the complications of the intragastric balloon procedure, despite its rarity.

Candida albicans colonization on an intragastric balloon

“…The first report of invasion of an intragastric balloon surface by bacteria, a known occurrence with other medical devices, was by Coskun and Bozkurt . In their case, Candida species not further identified, as well as Enterobacter cloacae, were found colonized on the balloon, though the stomach was macroscopically unharmed.…”

“…Their report did not suggest a possible cause of colonization other than the patient's history of heavy smoking; the 21‐year‐old was otherwise asymptomatic. Thus, they attribute colonization to delayed gastric emptying, where “the slowing down of normal gastric peristalsis by the intragastric balloon may [have allowed] opportunistic organisms to colonize more rapidly” . However, they found it in only one out of 201 endoscopic removals and we in only one out of 500 similar cases .…”

“…Thus, they attribute colonization to delayed gastric emptying, where “the slowing down of normal gastric peristalsis by the intragastric balloon may [have allowed] opportunistic organisms to colonize more rapidly” . However, they found it in only one out of 201 endoscopic removals and we in only one out of 500 similar cases . Additionally, their subject was taking proton pump inhibitors for gastric hyperacidity.…”

Fungal colonization of intragastric balloons

“…Fungal and bacterial colonization can occur on the surface of intragastric balloons. Various predisposing factors such as gastric stasis, antiacid drugs, and smoking may play a role in opportunistic infections in patients with intragastric balloons [4]. Spontaneous deflation of the balloon may be a risk factor as in the second patient discussed above.…”

Endoscopic bariatric and metabolic therapies: Another tool for the management of diabetes and obesity

“…Other serious adverse events that have been reported with IGBs include hyperinflation, acute pancreatitis, esophageal mucosal injury during placement or removal, fungal colonization of the balloon, and aspiration pneumonitis …”