R E M O V A L
P
LIT-‐8100-‐
R O C E D U R E S
-‐0005-‐01
Balloon
Remov
The
following
informa;on
the
personnel
performing
administering
any
balloons
• Proper
prepara6on
and
necessary
to
safely
perfo
• Failure
to
follow
this
info
prolonged/difficult
proce
LIT-‐8100-‐
val
Prepara6on
should
be
reviewed
with
gastroscopies
prior
to
s
the
correct
tools
are
orm
removal
procedures
orma6on
may
result
in
edures
or
pa6ent
injury
-‐0005-‐01
Balloon
Removal
Pr
1. Anesthe6ze
pa6ent
per
hospital
p
intuba6on
has
been
the
preferred
2. Insert
gastroscope
and
confirm
sto
clinical
condi6ons
that
warrant
po
3. View
all
balloons
4. Insert
the
puncture/aspira6on
nee
the
scope
and
puncture
the
balloo
5. Aspirate
the
balloon
using
suc6on
6. Remove
the
needle
and
insert
the
of
the
scope
7. Grasp
the
aspirated
balloon
and
sl
esophagus
and
mouth
8. Repeat
for
any
addi6onal
balloons
LIT-‐8100-‐
rocedure
Summary
protocol.
Conscious
seda6on
and
no
d
method
to
date
omach
is
empty
and
that
there
are
no
ostponement
of
the
procedure
edle
through
the
working
channel
of
on
n
or
a
60
cc
syringe
e
graspers
through
the
working
channel
lowly
extract
the
balloon
through
the
s
-‐0005-‐01
Recommended
A
Aspira;on
Needle
Requirements
• Injector
Needle
in
Teflon
Sleeve
• 21
–
25
Gauge
Lumen
• Needle
length
≥
6
mm
Suggested
tools
based
on
clinical
studie
• Olympus
NM-‐200L-‐0821
• Olympus
NM-‐200L-‐0623
• Olympus
NM-‐200L-‐0625
• Cook
G22525
Other
tools
have
not
been
tested
and
a
recommended.
Tools
for
other
manufacturers’
gastric
b
not
recommended.
LIT-‐8100-‐
Aspira6on
Needle
es
are
not
balloons
are
-‐0005-‐01
Important
Notes
• Needles
<
6
mm
may
be
maintain
in
the
balloon
w
• >
25
G
have
lumens
that
result
in
longer
and
more
• <
21
G
have
lumens
that
resul6ng
in
larger
than
n
difficult
aspira6on
if
>
1
p
LIT-‐8100-‐
s
on
Needle
Size
too
short
and
difficult
to
while
aspira6ng
t
are
too
small
and
may
e
difficult
aspira6on
t
are
unnecessarily
large
necessary
holes
and
puncture
occurs
-‐0005-‐01
Recommended
G
Forceps
Requirements
• Opening
width
≥
15
mm
• Rat-‐tooth
Alligator
or
2
jaw
grasping
forceps
(recommended)
• 2-‐prong
graspers
may
also
be
used
Suggested
forceps
based
on
clinical
studies
• Olympus
FG-‐49L-‐1
• 1800Endoscope.com
SF1239
• ESS
Forked
Jaw
Grasper
• EndoFlex
MAGNA
04
Other
tools
have
not
been
tested
and
are
no
recommended
Tools
for
other
manufacturers’
gastric
balloons
are
not
recommended.
Grasping
Forceps
ESS
Forked
Jaw
Olympus
FG-‐49L-‐1
ot
EndoFlex
MAGNA
04
SF1239
LIT-‐8100-‐0005-‐01
Important
Notes
on
P
Puncturing
the
Balloon
• For
easier
puncture,
inflate
air
• The
balloon
may
be
punctu
film.
Some
have
reported
t
more
difficult
• More
than
one
puncture
m
difficult
aspira6on
Aspira;on
may
be
performed
manually
• Manual
aspira6on
with
60c
least
4-‐5
syringes
LIT-‐8100-‐
Puncture
&
Aspira6on
e
the
stomach
with
less
ured
anywhere
on
the
that
the
seam
may
be
may
result
in
more
d
with
vacuum
or
cc
syringe
will
require
at
-‐0005-‐01
Normal
Appeara
Fully
inflated
balloon
at
Temperature
normal
stomach
posi;ve
pres
temperature
and
during
endos
pressure
change
appea
LIT-‐8100-‐
ance
of
Balloons
e
and
Temperature
change
ssure
during
endoscopy
may
scopy
may
cause
condensa;on
arance
-‐0005-‐01
Where
to
Grasp
the
Balloon
should
always
be
grasped
at
the
seam,
ideally
at
the
6:00
posi@on
opposite
the
valve
Balloon
Seam
12:00
Good
9:00 Apex 3:00
Poor (Top
or
Bottom) Poor
Worst
6:00
Optimal
LIT-‐8100-‐
e
Aspirated
Balloon
Posi;on
Descrip;on
Preference
6:00
Opposite
valve
Op6mal
12:00
on
seam
Good
3:00
Near
valve
on
seam
Poor
9:00
90°
with
respect
Poor
Apex
to
valve,
but
on
(Top
or
BoSom)
seam
Worst.
90°
with
respect
Re-‐grasp
at
to
valve,
but
on
beher
seam
posi6on.
Top
or
bohom
farthest
away
from
seam
-‐0005-‐01
Grasp
Loca6
Grasping
at
the
seam
at
the
6:00
po
shape
to
facilitate
the
easiest
remov
Op;mal
6:00
Loca;on
Lower
Profile
Shape
LIT-‐8100-‐
6on
Mahers
osi@on
creates
the
lowest
profile
val
Worst
Apex
Loca;on
Higher
Profile
Shape
-‐0005-‐01
Passage
throug
• Balloon
should
be
adjacent
to
dista
the
EG
junc6on
Preferred
LIT-‐8100-‐
gh
EG
Junc6on
al
end
of
scope
during
pull-‐through
Not
Preferred
-‐0005-‐01
When
to
Rem
All
balloons
must
be
remove
months
• Pa6ents
should
be
reminde
balloon
removals
aier
3
m
• Pa6ents
should
be
instruct
guidelines
prior
to
gastrosc
protocol
Failure
to
remove
balloons
a
likelihood
of
spontaneous
de
events
LIT-‐8100-‐
move
Balloons
ed
by
gastroscopy
aXer
3
ed
of
the
importance
of
months
ted
to
fast
and
follow
other
copy
according
to
hospital
aXer
3
months
increases
the
efla;on
and
other
adverse
-‐0005-‐01