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A simplified technique for the extirpation of the gastric bubble using an endo-overtube.

Since 1982, the medical literature as well as the lay press discussed an artificial bezoar, the gastric bubble, as an adjuvant in the treatment of morbid obesity. Approved by the FDA, the Garren-Edwards Gastric Bubble has been reported by the company to have been placed over 17,000 times. Due to a reported increased rate of deflation after three months, removal and reimplantation of a new bubble is recommended. After deflation, some difficulty in retrieval of the bubble has been reported. The authors report a new technique for bubble extraction. The bubble is visualized through a gastroscope and deflated using bicap cautery. The gastroscope is removed. The endo-overtube is placed on the gastroscope and this assembly is reintroduced through the esophagus to the level of the GE junction. The deflated bubble is visualized, grasped with a forceps, and withdrawn into the endo-overtube until becoming wedged. The entire assembly (gastroscope, overtube, forceps, and gastric bubble) are removed. With this technique, bubble removal has been simplified and has decreased the procedure length to approximately fifteen minutes.