Troubleshooting Intragastric Balloon Removal with Standard Biopsy Forceps

In response to the article titled “A novel method for removal of a partially deflated intragastric balloon,”1Sood S. Kamboj A.K. Storm A.C. Coelho-Prabhu N. A novel method for removal of a partially deflated intragastric balloon.VideoGIE. 2023; 8: 301-303Google Scholar we offer a simple alternative to the use of endoscopic scissors. Standard biopsy forceps, accessible to all endoscopists and used routinely, are a suitable initial option for puncturing silicone fluid-filled balloons such as Orbera (Apollo Endosurgery, Austin, Tex, USA) and Spatz3 (Spatz FGIA, Great Neck, NY, USA). Beyond ready availability and technical ease, biopsy forceps are more cost efficient. Additionally, endoscopic scissors may have difficulty gripping the smooth, curved surface of a filled balloon, whereas the serrated teeth of forceps easily grab and tear silicone effectively Fig. 1. This approach is useful in 4 additional scenarios where it is necessary to tear the balloon to deflate, remove, and potentially replace it (Table 1). Neither Spatz3 nor Orbera has published manufacturer guidance addressing these specific scenarios.Table 1Scenarios in which tearing an intragastric balloon with forceps may be helpfulScenarioProcedure typeIntragastric balloonPremature placement catheter dislodgementBalloon placement or adjustmentOrberaFill catheter ruptureBalloon placement or adjustmentSpatz3Needle instrument dislodgment before full deflationBalloon removalOrberaInadvertent damage to balloonBalloon placement, adjustment, or removalOrbera or Spatz3 Open table in a new tab Given the simplicity, efficiency, and cost effectiveness of biopsy forceps, we hope that readers will feel confident and empowered in troubleshooting common intragastric balloon technical challenges. Dr Maselli is a consultant for Apollo Endosurgery and has received food and beverages from Micro-tech Endoscopy USA Inc. Dr McGowan is a former consultant for Apollo Endosurgery and has received food and beverages from Novo Nordisk Inc. Dr Donnangelo disclosed no financial relationships relevant to this publication.