CPT® Code 43291

1. Indications

The procedure is indicated for patients who have a previously placed intragastric bariatric balloon that requires removal. This may be due to various reasons, including:

• Removal after treatment duration: The balloon is typically placed for a specific period to assist with weight loss, and its removal is necessary once the treatment period is completed.
• Complications: Patients may experience complications such as balloon deflation, migration, or discomfort, necessitating its removal.
• Patient preference: Some patients may choose to have the balloon removed due to personal reasons or changes in their weight loss goals.

2. Procedure

The procedure involves several critical steps to ensure the safe removal of the intragastric bariatric balloon:

• Step 1: The patient is placed under appropriate sedation to ensure comfort throughout the procedure. This is crucial for minimizing discomfort and anxiety during the endoscopic examination.
• Step 2: A flexible upper endoscope is then inserted transorally, meaning it is passed through the mouth and into the esophagus. The endoscope is advanced carefully into the proximal stomach, allowing for visualization of the internal structures.
• Step 3: Once in the stomach, any liquid contents are suctioned out to provide a clear view of the gastric lining. The stomach is then insufflated with air to expand it, facilitating a thorough inspection.
• Step 4: The endoscope is passed through the pylorus into the duodenum, where it is also inspected for any abnormalities. This step is essential for assessing the condition of the upper gastrointestinal tract.
• Step 5: After the duodenum is inspected, the endoscope is slowly withdrawn while suctioning air, allowing for a re-evaluation of both the duodenum and stomach.
• Step 6: The previously placed bariatric balloon is visualized during this inspection. A specialized needle is then inserted through the catheter to puncture the balloon, allowing for the suction of fluid from within it.
• Step 7: Once the balloon is fully deflated, the needle is removed. A retrieval instrument is then utilized to grasp the balloon, bringing it into alignment with the endoscope for safe removal.
• Step 8: The endoscope is reinserted and advanced to the duodenal bulb, where the mucosa is inspected for any signs of injury or abnormalities.
• Step 9: The stomach is reinsufflated, and any remaining fluid is suctioned out. The physician conducts a final inspection of the stomach and esophagus to ensure there are no complications.
• Step 10: Measurements are taken of the gastroesophageal (GE) junction and other normal anatomical landmarks. The presence of any hiatal hernia or other abnormalities is noted, and brushings or washings may be obtained for further analysis.
• Step 11: Finally, the endoscope is withdrawn, completing the procedure.

3. Post-Procedure

After the procedure, patients are typically monitored for any immediate complications related to the sedation and the procedure itself. They may experience some discomfort or bloating due to the insufflation of air during the procedure. It is essential for healthcare providers to provide post-procedure instructions, which may include dietary modifications and signs of potential complications to watch for, such as severe abdominal pain or vomiting. Follow-up appointments may be scheduled to assess the patient's recovery and discuss further weight management strategies if necessary.