BEUDAMED
    FDA Adverse Event Death Summary report: N

    ORBERA INTRAGASTRIC BALLOON SYSTEM

    MDR report key: 7160722 · Received January 3, 2018

    Report

    Report Number
    3006722112-2018-00004
    Event Type
    Death
    Date Received
    January 3, 2018
    Date of Event
    November 7, 2016
    Report Date
    December 7, 2017
    Manufacturer
    APOLLO ENDOSURGERY, INC.
    Product Code
    LTI
    PMA / PMN Number
    P140008
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    UK
    Reporter Occupation
    RISK MANAGER

    Narratives

    Additional Manufacturer Narrative · 1

    IT IS UNKNOWN IF THE DEVICE WILL BE RETURNED TO APOLLO FOR ANALYSIS. DEVICE LABELING ADDRESSES THE REPORTED EVENT AS FOLLOWS: INDICATIONS FOR USE: CAUTION: THE RISK OF BALLOON DEFLATION AND INTESTINAL OBSTRUCTION (AND THEREFORE POSSIBLE DEATH RELATED TO INTESTINAL OBSTRUCTION) IS SIGNIFICANTLY HIGHER WHEN BALLOONS ARE LEFT IN PLACE LONGER THAN 6 MONTHS. THIS HAS ALREADY BEEN EXPERIENCED. WARNINGS AND PRECAUTIONS: THE RISK OF BALLOON DEFLATION AND INTESTINAL OBSTRUCTION (AND THEREFORE POSSIBLE DEATH RELATED TO INTESTINAL OBSTRUCTION) IS SIGNIFICANTLY HIGHER WHEN BALLOONS ARE LEFT IN PLACE LONGER THAN 6 MONTHS OR USED AT LARGER VOLUMES (GREATER THAN 700 CC). BOWEL OBSTRUCTIONS HAVE BEEN REPORTED DUE TO DEFLATED BALLOONS PASSING INTO THE INTESTINES AND HAVE REQUIRED SURGICAL REMOVAL. SOME OBSTRUCTIONS HAVE REPORTEDLY BEEN ASSOCIATED WITH PATIENTS WHO HAVE DIABETES OR WHO HAVE HAD PRIOR ABDOMINAL SURGERY, SO THIS SHOULD BE CONSIDERED IN ASSESSING THE RISK OF THE PROCEDURE. BOWEL OBSTRUCTIONS CAN RESULT IN DEATH. PROPER POSITIONING OF THE PLACEMENT CATHETER ASSEMBLY AND THE ORBERA® SYSTEM BALLOON WITHIN THE STOMACH IS NECESSARY TO ALLOW PROPER INFLATION. LODGING OF THE BALLOON IN THE ESOPHAGEAL OPENING DURING INFLATION MAY CAUSE INJURY AND/OR DEVICE RUPTURE. THE PHYSIOLOGICAL RESPONSE OF THE PATIENT TO THE PRESENCE OF THE ORBERA® SYSTEM BALLOON MAY VARY DEPENDING UPON THE PATIENT'S GENERAL CONDITION AND THE LEVEL AND TYPE OF ACTIVITY. THE TYPES AND FREQUENCY OF ADMINISTRATION OF DRUGS OR DIET SUPPLEMENTS AND THE OVERALL DIET OF THE PATIENT MAY ALSO AFFECT THE RESPONSE. COMPLICATIONS: DEATH DUE TO COMPLICATIONS RELATED TO INTESTINAL OBSTRUCTION IS POSSIBLE. INJURY TO THE DIGESTIVE TRACT DURING PLACEMENT OF THE BALLOON IN AN IMPROPER LOCATION SUCH AS IN THE ESOPHAGUS OR DUODENUM. THIS COULD CAUSE BLEEDING OR EVEN PERFORATION, WHICH COULD REQUIRE A SURGICAL CORRECTION FOR CONTROL. INJURY TO THE LINING OF THE DIGESTIVE TRACT AS A RESULT OF DIRECT CONTACT WITH THE BALLOON, GRASPING FORCEPS, OR AS A RESULT OF INCREASED ACID PRODUCTION BY THE STOMACH. THIS COULD LEAD TO ULCER FORMATION WITH PAIN, BLEEDING OR EVEN PERFORATION. SURGERY COULD BE NECESSARY TO CORRECT THIS CONDITION. COMPLICATIONS OF ROUTINE ENDOSCOPY INCLUDE: DIGESTIVE TRACT INJURY OR PERFORATION. BALLOON PLACEMENT AND INFLATION: FILLING SHOULD ALWAYS BE COMPLETED UNDER DIRECT VISUALIZATION (GASTROSCOPY). INTEGRITY OF THE VALVE SHOULD BE CONFIRMED BY OBSERVING THE VALVE LUMEN AS THE BALLOON FILL TUBE IS REMOVED FROM THE VALVE. A BALLOON WITH A LEAKING VALVE MUST BE REMOVED IMMEDIATELY. A DEFLATED BALLOON CAN RESULT IN A BOWEL OBSTRUCTION, WHICH CAN RESULT IN DEATH. BOWEL OBSTRUCTIONS HAVE OCCURRED AS A RESULT OF UNRECOGNIZED OR UNTREATED BALLOON DEFLATION.

    Description of Event or Problem · 1

    REPORTED AS: HEALTHCARE PROFESSIONAL REPORTED AN ORBERA INTRAGASTRIC BALLOON PATIENT'S DEATH DUE TO "INTESTINAL PERFORATION FOLLOWING INSERTION OF GASTRIC BALLOON. PATIENT HAD EXPERIENCED "INTOLERANCE" SYMPTOMS SUCH AS NAUSEA, EMESIS, ABDOMINAL DISCOMFORT, INABILITY TO TOLERATE LIQUID OR FOOD IN ANY AMOUNTS. COMPUTED TOMOGRAPHY (CT) SCAN DEMONSTRATED GASTRIC PERFORATION."

    Description of Event or Problem · 1

    CLARIFICATION OF INFORMATION RECEIVED FROM THE INITIAL REPORTER OF "INTESTINAL PERFORATION" NOTED THE EVENT WAS DIAGNOSED BY CT SCAN AS A GASTRIC PERFORATION ONLY.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    6199 ORBERA INTRAGASTRIC BALLOON SYSTEM INTRAGASTRIC BALLOON LTI APOLLO ENDOSURGERY, INC. NI NI

    Patients

    Seq Age Sex Outcome Treatment
    1 66 YR Death