Gastric balloons are used as a minimally invasive treatment for obesity in patients who have not achieved adequate weight loss through lifestyle modification and who may not be suitable for bariatric surgery. Randomised controlled trials and meta-analyses show that fluid-filled intragastric balloons achieve mean total body weight loss of 10–15% at 6–8 months, compared to 3–4% with lifestyle intervention alone (1, 2). The aim of this study was to evaluate outcomes, technical success, complications, and healthcare utilisation (including financial impact) associated with gastric balloon removal in a UK NHS bariatric centre, with a particular focus on devices inserted overseas through medical tourism.

A five-year retrospective review was undertaken of all gastric balloon removal procedures between October 2020 and October 2025. Data were collected from endoscopy reporting software for all patients undergoing oesophagogastroduodenoscopy (OGD) for balloon removal using a dedicated endoscopic gastric balloon removal kit. Electronic patient records provided additional information including presenting symptoms, number of OGD attempts, procedural challenges, complications, cross-sectional imaging, length of hospital stay, balloon insertion origin, and weight-loss reporting.

To estimate the financial burden to the NHS, we used publicly available NHS reference-cost benchmarks to approximate the mean healthcare cost per emergency admission for gastric balloon removal, incorporating inpatient stay, cross-sectional imaging, anaesthetic support, and therapeutic endoscopy.

A total of 51 OGD balloon removal attempts were performed for 48 patients. Presenting symptoms included abdominal pain, nausea, vomiting, and reflux. One patient presented with acute pancreatitis, believed to be secondary to the gastric balloon.

Most patients (n=46) required a single procedure, while two required two attempts: one due to intolerance of sedation (later removed under general anaesthesia), and another in whom balloon deflation was achieved initially but retrieval required a second OGD. Successful removal was achieved in 98% of cases, with one patient awaiting removal under GA.

Technical 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 (48%), including four at external centres. 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.

Balloon insertion occurred predominantly outside the UK: 31 from Turkey, 2 from Brazil, 1 from Albania, 1 from the Czech Republic; 9 were inserted in the UK (mostly private providers), and 4 had undocumented origin. Documentation regarding planned removal was poor: 8 patients had confirmed dates, 3 had general timeframes, 3 had no documented plan, and 31 had no recorded information.

Cost analysis: Using current NHS reference-cost benchmarks (5), the estimated mean cost per emergency admission for gastric balloon removal was £3,040, with a plausible range of £1,800–£5,500 depending on duration of admission, imaging requirements, anaesthetic input, and procedural complexity. The largest contributors were inpatient stay, cross-sectional imaging, and therapeutic endoscopy. The total projected cost to the hospital over the 5-year period was approximately £158,100.

This five-year review demonstrates that endoscopic gastric balloon removal can be performed safely and with high technical success. However, most balloons were inserted privately and internationally, with no follow-up and removal planning. The frequent need for admission, imaging, and specialist endoscopy creates a significant unplanned financial burden on NHS services.

With the increasing availability of effective pharmacological weight-loss therapies such as GLP-1 agonists (2, 3) and newer endoscopic bariatric techniques such as endoscopic sleeve gastroplasty (4), gastric balloons may become less favoured. Establishing clearer follow-up pathways, improving patient education, and addressing risks associated with international health tourism may help reduce unnecessary NHS resource utilisation.