Title: Contamination of Single Fluid-Filled Intragastric Balloons with Orogastric Fluid is not
Associated with Hyperinflation: An Ex-vivo Study and Systematic Review of Literature
Version: 1 Date: 09 May 2021
Reviewer:  Katerina Kotzampassi
Reviewer's report:
The present scientific work is a sophisticated combination of a review of the literature [just 10
publications – 11 cases] plus an ex-vivo experiment. The authors try to investigate the reported
phenomenon of spontaneous hyperinflation of fluid-filled intragastric balloons # which may be
the cause of abdominal discomfort in a few cases in the literature # which led the FDA to issue
an update for potential risk.
It is a well-designed and well-written study.
I have only two comments to the experimental part:
1. The size of the balloon “they measured in two dimensions using a flexible tape” is called
“perimeter” and not “diameter”. This is also prominent by the number they present, 33,5cm
2. The authors used orogastric contents to “contaminate” the balloon filling, simulating the entry
of gastric contents into the balloon either through its valve or by means of wall permeability.
Whatever the mechanism, if any, the majority of patients remain under proton pump inhibitors
treatment throughout the 6mo having the balloon in the stomach; that means their gastric content
is of less acidity [higher pH] in relation to that used in their experiment. I would like to read
a comment on it.
Katerina Kotzampassi, MD, PhD
Surgeon-Endoscopist
Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
Title: Contamination of Single Fluid-Filled Intragastric Balloons with Orogastric Fluid is not
Associated with Hyperinflation: An Ex-vivo Study and Systematic Review of Literature
Version: 1 Date: 09 May 2021
Reviewer:  Katerina Kotzampassi
Reviewer's report:
The present scientific work is a sophisticated combination of a review of the literature [just 10
publications – 11 cases] plus an ex-vivo experiment. The authors try to investigate the reported
phenomenon of spontaneous hyperinflation of fluid-filled intragastric balloons # which may be
the cause of abdominal discomfort in a few cases in the literature # which led the FDA to issue
an update for potential risk.
It is a well-designed and well-written study.
I have only two comments to the experimental part:
1. The size of the balloon “they measured in two dimensions using a flexible tape” is called
“perimeter” and not “diameter”. This is also prominent by the number they present, 33,5cm
2. The authors used orogastric contents to “contaminate” the balloon filling, simulating the entry
of gastric contents into the balloon either through its valve or by means of wall permeability.
Whatever the mechanism, if any, the majority of patients remain under proton pump inhibitors
treatment throughout the 6mo having the balloon in the stomach; that means their gastric content
is of less acidity [higher pH] in relation to that used in their experiment. I would like to read
a comment on it.
Katerina Kotzampassi, MD, PhD
Surgeon-Endoscopist
Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
Please review this paper.
user
Title: Contamination of Single Fluid-Filled Intragastric Balloons with Orogastric Fluid is not
Associated with Hyperinflation: An Ex-vivo Study and Systematic Review of Literature
Version: 1 Date: 09 May 2021
Reviewer:  Katerina Kotzampassi
Reviewer's report:
The present scientific work is a sophisticated combination of a review of the literature [just 10
publications – 11 cases] plus an ex-vivo experiment. The authors try to investigate the reported
phenomenon of spontaneous hyperinflation of fluid-filled intragastric balloons # which may be
the cause of abdominal discomfort in a few cases in the literature # which led the FDA to issue
an update for potential risk.
It is a well-designed and well-written study.
I have only two comments to the experimental part:
1. The size of the balloon “they measured in two dimensions using a flexible tape” is called
“perimeter” and not “diameter”. This is also prominent by the number they present, 33,5cm
2. The authors used orogastric contents to “contaminate” the balloon filling, simulating the entry
of gastric contents into the balloon either through its valve or by means of wall permeability.
Whatever the mechanism, if any, the majority of patients remain under proton pump inhibitors
treatment throughout the 6mo having the balloon in the stomach; that means their gastric content
is of less acidity [higher pH] in relation to that used in their experiment. I would like to read
a comment on it.
Katerina Kotzampassi, MD, PhD
Surgeon-Endoscopist
Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
assistant