Endoscopic Balloon Removal (Intragastric Balloon Retrieval)

Intragastric balloons are temporary. Every balloon must eventually come out (Lingvay et al., Lancet, 2024). The timeline depends on the device:

• Endoscopically placed fluid-filled balloons, such as Orbera, are typically removed by endoscopy after about 6 months (Telem and Ghaferi, JAMA, 2020).

• The swallowable Allurion balloon is designed to open on its own after about 4 months and pass naturally. A small number of patients still need endoscopic removal for intolerance or complications (Jirapinyo and Thompson, Digestive Diseases and Sciences, 2022).

Endoscopic balloon removal is a short outpatient procedure. A flexible endoscope passes through the mouth, the balloon is punctured and drained, and the empty shell is grasped and carefully withdrawn (Laing et al., Digestive Diseases and Sciences, 2017).

Removal is routine, but technique and preparation matter. The most feared risks are:

• Aspiration of stomach contents into the lungs

• Injury to the esophagus as the balloon is pulled through its narrow points

Both are rare in experienced hands (Ribeiro et al., Obesity Surgery, 2021; Espinet-Coll et al., Obesity Surgery, 2024).

Removal is also the most important turning point in balloon therapy. Studies consistently show significant weight regain after the device comes out unless a maintenance plan is in place (Lingvay et al., Lancet, 2024). Our practice treats removal as the start of the next phase, not the end of treatment.

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• Empty stomach first. A liquid diet and fasting period clear food from the stomach so the airway stays protected (Brill et al., AGA White Paper, 2017).

• Puncture and drain. A retractable needle passes through the endoscope into the balloon, and suction removes the saline until the balloon fully collapses (Laing et al., Digestive Diseases and Sciences, 2017).

• Grasp and extract. The deflated shell is captured with a snare or grasping forceps and slowly drawn up through the esophagus with the scope (Fittipaldi-Fernandez et al., Obesity Surgery, 2020).

• Inspect. A second look checks the stomach and esophagus for any irritation, ulcer, or tear, so it can be treated immediately (Ribeiro et al., Obesity Surgery, 2021).

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• Completes balloon therapy safely and on schedule. Leaving a balloon in past its approved time raises the risk of deflation, migration into the intestine, and blockage (Espinet-Coll et al., Obesity Surgery, 2024).

• Quick relief for patients who can't tolerate their balloon. Persistent nausea, vomiting, and pain are the most common reasons for early removal (Apovian et al., Clinical Management of Obesity, The Obesity Society, 2025).

• Rapid treatment of complications. For hyperinflation, moderate-to-severe pancreatitis, ulcers, or deflation, prompt removal is the mainstay of treatment (Ribeiro et al., Obesity Surgery, 2021).

• No incisions, and same-day discharge for most patients.

• A built-in transition plan. Patients leave with a maintenance strategy, such as nutrition coaching, medication, a second balloon, an endoscopic procedure, or surgery.

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• Scheduled removal. Patients who have completed their approved balloon treatment period.
• Early removal for intolerance. Patients with persistent vomiting, dehydration, or pain despite anti-nausea and antispasmodic medication. Rates vary by study:
  • About 7.5% of Orbera patients in a meta-analysis (Abu Dayyeh et al., AGA Clinical Practice Update, 2017)
  • 2.2% in a 41,866-patient series (Ribeiro et al., Obesity Surgery, 2021)
• Urgent removal for complications:
  • Spontaneous hyperinflation. It was reported in 2.3% of patients in the Orbera post-approval study (Shah et al., AGA Technical Review, 2021).
  • Acute pancreatitis. Removal is required in moderate or severe cases (Espinet-Coll et al., Obesity Surgery, 2024).
  • Balloon deflation or rupture. Endoscopic removal within 72 hours is recommended to prevent migration into the bowel (Espinet-Coll et al., Obesity Surgery, 2024).
  • Gastric ulcer, bleeding, or gastric outlet obstruction

• Allurion balloons that don't pass on their own, or that cause intolerance before they open. These are removed the same way as other fluid-filled balloons (Jamal et al., Obesity Surgery, 2019).

• Balloons placed elsewhere or abroad. This includes patients who lost follow-up, are overdue for removal, or don't know their device type.

• Unplanned pregnancy during balloon therapy, evaluated on a case-by-case basis.

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1. Anesthesia. Removal is performed under anesthesia, with airway protection tailored to your stomach contents and risk. Several experts recommend general anesthesia with a breathing tube to protect the airway (Ribeiro et al., Obesity Surgery, 2021; Espinet-Coll et al., Obesity Surgery, 2024). Large series have also reported no aspiration under deep sedation with strict preparation (Fittipaldi-Fernandez et al., Obesity Surgery, 2020).
2. Endoscopic survey. If solid food remains in the stomach, the team suctions it, protects the airway, or reschedules (Brill et al., AGA White Paper, 2017).
3. Puncture and aspiration. The balloon is punctured with a needle catheter and drained completely by suction (Laing et al., Digestive Diseases and Sciences, 2017).
4. Capture. The shell is grasped with a snare or rat-tooth forceps.
5. Controlled extraction. The balloon is drawn up through the esophagus. Medication to relax the sphincter muscles and gentle neck extension help ease passage through the throat (Laing et al., Digestive Diseases and Sciences, 2017; Fittipaldi-Fernandez et al., Obesity Surgery, 2020).
6. Re-inspection. The stomach and esophagus are rechecked for injury, which can be treated on the spot if found (Ribeiro et al., Obesity Surgery, 2021).

Typical procedure time is about 15–30 minutes.

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• Overall, removal is very safe. Perforation during removal occurred in 0.01% of 41,866 patients (Ribeiro et al., Obesity Surgery, 2021).

• Esophageal tear or laceration. When it happens, it's usually at the gastroesophageal junction or the upper esophageal sphincter, where the esophagus naturally narrows. Most injuries are recognized during the procedure and closed with clips or a stent (Ribeiro et al., Obesity Surgery, 2021).

• Aspiration of stomach contents. This is the most feared anesthetic risk, and it's minimized by a liquid diet, fasting, and airway protection (Espinet-Coll et al., Obesity Surgery, 2024).

• Sore throat for a day or two.
• Higher-risk situations:
  • Severe erosive esophagitis. It should be treated before removal to lower the risk of esophageal injury (Espinet-Coll et al., Obesity Surgery, 2024).
  • A balloon that has migrated into the intestine. It may need enteroscopy or laparoscopic surgery (Espinet-Coll et al., Obesity Surgery, 2024; Jamal et al., Obesity Surgery, 2019).

• FDA safety communications have described hyperinflation, acute pancreatitis, and deaths in patients with liquid-filled balloons. The reported deaths were related mainly to gastric or esophageal perforation (Shah et al., AGA Technical Review, 2021). Removal by a team that can manage any complication matters.

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• Discharge home the same day, once awake.

• Diet: clear liquids the first day, advancing to soft foods and then a regular diet as tolerated.

• Return to work: usually the next day.

• Call right away for chest or neck pain, trouble swallowing, fever, vomiting blood, or shortness of breath.

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• Some weight regain is common after removal. In a randomized trial, total weight loss was 10.2% at 6 months with the balloon and 7.6% six months after removal, compared with 3.3% and 3.1% with lifestyle changes alone (Elmaleh-Sachs et al., JAMA, 2023).

• Meta-analyses confirm significant regain after the device comes out (Lingvay et al., Lancet, 2024).

• Many patients keep most of their results. In one program with structured follow-up, 75% of patients kept more than 60% of their weight loss one year after removal (Keren and Rainis, Obesity Surgery, 2018).

• Starting BMI matters. Patients who started at BMI 35–49 regained more than those at BMI 27.5–34.9 (Jamal et al., Obesity Surgery, 2019). Balloons are best for lower-BMI patients, not for those with more severe obesity and related disease.

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More in Endoscopic Weight-Loss Procedures

Related procedures: Medical Weight Loss Program, Gastric Balloon, Orbera Intragastric Balloon, Allurion Balloon, Transoral Outlet Reduction. For an overview of all options, see Endoscopic Sleeve Gastroplasty.

Conditions treated: Obesity, Overweight, Weight Regain, Metabolic Adaptation.

Dr. Nestor de la Cruz-Muñoz, MD, FACS, DABOM, has performed bariatric endoscopy since 2007, beginning with the early ROSE procedures that preceded ESG, and has served as Principal Investigator for 6 different bariatric endoscopic FDA pivotal trials. He was also one of the early physician adopters of gastric balloons after they were FDA approved in 2015.

As a board-certified metabolic and bariatric surgeon offering everything from endoscopic therapies like TORe and ESG to primary and revision surgery, Dr. de la Cruz-Muñoz can give balloon patients an unbiased, individualized recommendation for what comes after removal, along with a seamless pathway to ESG or surgery if their needs change.

• Educator of surgeons. He served for 10 years as a surgical fellowship program director, training surgeons in advanced bariatric, foregut, and endoscopic surgery.

• Balloons placed anywhere. That includes removal of balloons placed at other centers or abroad, for patients who are overdue, lost to follow-up, or having symptoms.
• The full weight loss continuum under one roof:
  • Medical Weight Loss Program, including GLP-1 medications
  • Gastric Balloon, Orbera Balloon, and Allurion Balloon
  • Endoscopic Sleeve Gastroplasty (ESG)
  • Sleeve Gastrectomy, Gastric Bypass (RYGB), and SADI-S

• Honest guidance. Balloons are temporary tools. If your health needs call for a durable treatment, he'll tell you, and he can provide it.

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Behind every balloon removal is a surgeon who can handle whatever the endoscopy shows. Dr. de la Cruz-Muñoz has over 25 years in bariatric surgery and more than 9,000 bariatric operations, a volume few surgeons reach.

What happens to your weight after the balloon is out:

• Typical results at removal:
  • Orbera: about 10–13% total body weight loss at 6 months (Abu Dayyeh et al., AGA Clinical Practice Update, 2017)
  • Allurion: about 12–14% at about 4 months (Jirapinyo and Thompson, Digestive Diseases and Sciences, 2022)

• Six months after removal: about 7.6% total weight loss remained in the pivotal trial (Elmaleh-Sachs et al., JAMA, 2023).

• Your long-term result depends on what you do next.

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• Improvements gained during balloon therapy in blood sugar, blood pressure, and liver enzymes last only as long as the weight loss does.

• After removal, metabolic gains depend on maintaining weight loss. That's why a maintenance plan starts the day of removal.

• Patients with type 2 diabetes, fatty liver disease, or sleep apnea often benefit more from durable treatment. See Sleeve Gastrectomy and Gastric Bypass (RYGB).

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The American Gastroenterological Association suggests these options after balloon removal (Muniraj et al., AGA Clinical Practice Guideline, 2021):

• Structured dietary therapy. Moderate- to high-intensity diets both augment and sustain weight loss after balloon therapy (Muniraj et al., AGA Clinical Practice Guideline, 2021).

• Anti-obesity medication, such as GLP-1 therapy, through our Medical Weight Loss Program.

• A sequential (second) balloon in selected patients.

• Endoscopic Sleeve Gastroplasty (ESG) for a more durable, incisionless option.

• Bariatric surgery for patients with higher BMI or metabolic disease. See Bariatric Surgery.

The choice is made together, through shared decision-making, based on your health, goals, and preferences.

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• Reflux affects about 18% of patients during balloon therapy (Abu Dayyeh et al., AGA Clinical Practice Update, 2017).

• Removal usually relieves balloon-related reflux.

• Severe erosive esophagitis is treated before removal to make the extraction safer (Espinet-Coll et al., Obesity Surgery, 2024).

• Persistent reflux after removal is evaluated separately. See GERD / Acid Reflux and Erosive (Reflux) Esophagitis.

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• Second balloon after an appropriate interval, in selected patients.

• Endoscopic Sleeve Gastroplasty (ESG)

• Sleeve Gastrectomy or Gastric Bypass (RYGB) for durable weight loss and metabolic improvement.
• Management of complications:
  • Balloon-related ulcers are treated with acid suppression and endoscopic follow-up.
  • A migrated balloon may need enteroscopy or laparoscopic retrieval (Espinet-Coll et al., Obesity Surgery, 2024).

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• Rapid early weight loss with a balloon can include muscle.

• InBody or DEXA testing at removal shows whether you lost fat or lean mass.

• A protein-forward diet and resistance training help preserve metabolic rate and protect against regain.

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• Routine removal is typically included in the self-pay balloon package, because most insurers don't cover intragastric balloon therapy.

• Urgent removal for a complication may be billed to insurance, depending on your plan.

• Removal of balloons placed elsewhere is priced separately. Our team reviews your device records and coverage before scheduling.

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• Bring your device information: balloon brand, placement date, fill volume, and the placing center, if available.

• Liquid diet before removal. Recommendations range from 2–3 days (Espinet-Coll et al., Obesity Surgery, 2024) to 5 days of clear liquids in large series (Fittipaldi-Fernandez et al., Obesity Surgery, 2020). Your team will give you exact instructions.

• Nothing by mouth for at least 12 hours before the procedure (Brill et al., AGA White Paper, 2017).

• Continue your PPI unless told otherwise.

• GLP-1 medications slow stomach emptying and are managed as directed by the anesthesia team.

• Arrange a ride home.

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• Day of removal: clear liquids.

• Days 1–2: full liquids and soft foods.

• After that: a structured, portion-controlled, high-protein eating plan.

• This is the most important nutrition period of balloon therapy. Appetite often returns once the balloon is out, so dietitian follow-up continues after removal.

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• Normal activity the next day.

• Resume exercise within 1–2 days as tolerated.

• Prioritize resistance training at least 2 days per week, plus regular aerobic activity, to protect muscle and maintain weight loss.

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Balloon removal is an outpatient endoscopy. Patients who had their balloon placed abroad, or who live outside the U.S., usually need only a one- to two-day stay. Please bring the balloon type and placement date.