{
  "abstract": "Introduction Gastric balloons are used for obesity management and require planned removal, yet follow-up is often poor after private overseas procedures. This study evaluates gastric balloon removal outcomes, complications, and NHS resource use and cost in a UK NHS bariatric centre, with a focus on medical tourism.Methods All endoscopic gastric balloon removal procedures between October 2020 and October 2025 at Homerton University Hospital were included. Data were retrospectively collected from endoscopy reporting software and electronic patient records, including presenting symptoms, number of OGD attempts, procedural challenges, complications, cross-sectional imaging, length of hospital stay, balloon insertion origin, and weight-loss reporting. NHS reference-cost benchmarks were used to estimate mean healthcare cost per emergency admission for gastric balloon removal, incorporating inpatient stay, imaging, anaesthetic support and therapeutic endoscopy.Results A total of 51 balloon removal attempts were performed for 48 patients. Presenting symptoms included abdominal pain, nausea, vomiting, and reflux. One patient presented with acute pancreatitis attributed to the balloon. Most patients required a single OGD (46/48, 96%), while two patients required two attempts: one due to sedation intolerance, and one due to delayed retrieval after successful balloon deflation. Successful removal was achieved in 98% of patients, with one patient awaiting removal under general anaesthesia. Procedural challenges included one overinflated balloon that ruptured during extraction and one case requiring an overtube to facilitate removal of friable debris. Cross-sectional imaging was performed in 23 patients, and median length of hospital stay was 2 days (range 1–10). Weight-loss data were inconsistently documented: 10 patients reported weight loss, 17 reported none, and information was unavailable for 21.35 patients had balloons inserted abroad (31 from Turkey, 2 from Brazil, 1 from Albania, and 1 from the Czech Republic), 9 in the UK (mostly private providers), and 4 had undocumented origin. Only 8 patients had confirmed removal dates documented, 3 had general timeframes, and 34 (71%) had no recorded plan. Estimated mean cost per emergency admission was £3,040 (range £1,800–£5,500), giving a projected 5-year total of ~£158,100.Conclusions Endoscopic gastric balloon removal achieved high technical success with few procedural complications. Most balloons were inserted overseas or privately with poor recorded removal planning, and removals commonly required admission and imaging, creating an unplanned NHS cost burden. Establishing standardised referral and follow-up pathways, improving patient education, and addressing risks associated with international health tourism may help reduce unnecessary NHS resource utilisation.",
  "authors": [
    {
      "affiliations": [
        "Homerton University Hospital, London, United Kingdom"
      ],
      "name": "Alice Buckley"
    },
    {
      "affiliations": [
        "Homerton University Hospital, London, United Kingdom"
      ],
      "name": "Shaan Kotecha"
    },
    {
      "affiliations": [
        "University College Hospital, London, United Kingdom"
      ],
      "name": "Tareq El Menabawey"
    },
    {
      "affiliations": [
        "Homerton University Hospital, London, United Kingdom"
      ],
      "name": "Ian Ewing"
    },
    {
      "affiliations": [
        "Homerton University Hospital, London, United Kingdom"
      ],
      "name": "Ray Shidrawi"
    },
    {
      "affiliations": [
        "Homerton University Hospital, London, United Kingdom"
      ],
      "name": "Sungjae Hwang"
    }
  ],
  "title": "P314 The hidden burden of international gastric balloon tourism: a five-year analysis of removal procedures performed at Homerton university hospital",
  "uid": "d3369747-85cb-58c0-8024-1886898a6f67"
}