Balloon placement
Balloon insertion was performed after a diagnostic endoscopy to detect pathologies that might contraindicate balloon placement, such as active peptic ulcers, grade C-D esophagitis, large volume hiatal hernia, esophageal / fundus varices, esophageal strictures and prior gastric surgery.
The endoscopy procedure was performed under deep sedation without endotracheal intubation, with continuous oxygen support with 5L/ min and under anesthesiologist supervision. After the passage of the balloon, correct positioning was checked endoscopically, with the balloon valve positioned 2 cm below the cardia. The balloon inflation was under direct vision with the endoscope in rear view position. The balloon was filled with 3% saline solution and 10mL of 4% methylene blue. The balloon volumes ranged from 600 to 700 mL.
After the filling, balloon valve was closed with a syringe vacuum and the catheter disconnected by traction. Then the balloon was visually inspected for possible deflation or valve malfunctions and to confirm correct positioning in the gastric fundus. If leakage was detected, prompt replacement of the defective balloon was conducted.