Obesity is a growing global health concern that can be addressed using various strategies, including lifestyle modifications, medications, endoscopic procedures, and bariatric surgery [1–4]. Intragastric balloons (IGBs) have been utilized for weight loss over the past two decades; however, their use is often limited by the need for hospitalization, upper gastrointestinal endoscopy, and anesthesia [5].

The Elipse™ intragastric balloon (EIGB) is a new swallowable device that does not have these limitations and has been proven to be safe, effective for weight loss, and well tolerated [6–11]. The EIGB is compressed into a vegan capsule attached to a thin catheter. After being swallowed with water, the balloon is filled with 550 mL of liquid once it reaches the stomach. A small radiopaque ring within the EIGB allows for confirmation of its correct position through abdominal X-ray.

After approximately four months, a valve in the EIGB opens, allowing the balloon to empty and pass naturally through the digestive system without requiring endoscopic removal. The most common adverse events after EIGB placement are nausea and vomiting, occurring in 73% (35/48) and 50% (24/48) of patients, respectively. These symptoms are typically self-limited or resolve with medication within two to three days [10, 12].

While EIGB is generally well tolerated, some side effects can occur, such as intolerance requiring early endoscopic removal (about 3% of cases) [10]. The most serious complication is obstruction, which can occur at various levels, such as gastric outlet obstruction or bowel obstruction due to balloon partial deflation and migration beyond the pylorus. These severe adverse effects are rare, occurring in less than 1% of cases [10, 12].

Recently, we observed two cases of bowel obstruction caused by partial deflation and migration of the EIGB beyond the pylorus. Both cases were successfully managed with ultrasonography (US)-guided aspiration of the migrated balloons, resulting in immediate symptom relief and rapid patient discharge.

Table 1 shows the timeline of the presented cases.

Table 2 summarizes diagnostic tools used in these cases, the type of treatment, and outcomes.

Both patients presented to the emergency room, deeply concerned about their abdominal pain. After their diagnosis was clarified, they consciously chose the proposed treatment: a non-invasive, US-guided intervention to deflate the obstructing EIGB. Following a quick and uneventful recovery, both patients expressed gratitude.

Our two cases confirm the diagnostic capabilities of US in detecting migrated EIGB. They also highlight the role of US-guided interventional maneuvers in treating impacted devices within a bowel loop. In both instances, the deflated and migrated EIGB was easily identified using the US. A simple, painless, and safe US-guided aspiration allowed for the excretion of the device, relieved the bowel obstruction, and prevented the need for surgical intervention.

Bibliographic research conducted on December 20, 2025, using the keywords [(Elipse intragastric balloon[Title/Abstract]) AND (ultrasonography[Title/Abstract])] retrieved no results. This suggests that our report is the first to propose US as a successful method for prompt diagnosis of EIGB-related obstructive complications and conservative management.

IGBs are commonly used as a temporary bridge therapy before surgery [13]. Most manufacturers recommend device removal after six months due to the increased risk of balloon deflation and migration. Bowel obstruction from migrated IGBs left in place longer than six months accounts for most published complications [14]. Early deflation of an EIGB (within six months), causing gastric outlet syndrome or bowel obstruction, is rare, up to 0.6% in one study [10]. This adverse event has been linked to earlier generations of the Elipse balloon, sometimes due to valve faults [8, 10]; however, our patients received the updated device. In our case, altered gastrointestinal motility and/or excessive gastric acid secretion triggered by the EIGB may have damaged the balloon valve.

The risk of balloon deflation and subsequent migration increases over time, but as seen in our cases, these complications can occur early, within the recommended six-month retrieval window.

Laparoscopic surgery is generally considered the preferred treatment for obstruction due to a partially deflated IGB. Imaging-guided percutaneous aspiration has been used rarely, in 3 out of 27 cases (11%) of bowel obstruction caused by various IGBs [11] and was not employed in two large multicenter studies on EIGB safety [8, 10]. We selected an 18 g needle over smaller gauges to ensure rapid evacuation of viscous balloon contents, balancing efficacy with safety based on our prior experience with gastrointestinal mass biopsies [15] and supporting literature [16]. Puncturing intestinal walls with an 18 g needle (even of the cutting type) has been demonstrated to be as safe as biopsies performed with smaller 20–22 g needles [15, 16].

We have previously recommended the US as the method of choice for monitoring Bioenterics Intragastric Balloon (BIB) complications and routinely use it to check intragastric devices for weight loss [17]. Our two cases suggest the potential role of the US not only as a diagnostic method for detecting migrated EIGB but also as a guidance tool for percutaneous treatment of impacted devices within a bowel loop. In both cases, the deflated and migrated EIGB was easily located with US, and a simple, painless, and safe US-guided aspiration facilitated device excretion, resolved bowel obstruction, and avoided surgery.

Although limited to only two cases, our experience suggests a potential role of US as a valuable tool for assessing migration of intragastric devices for weight loss beyond the pylorus in obese patients suitable for US exploration. Furthermore, when a safe access route is identified, US-guided needle aspiration of a partially deflated IGB causing bowel obstruction could offer a rapid and safe therapeutic option to avoid surgery. Further studies are needed to establish the role of the US in the management of bowel obstruction caused by partially deflated EIGB.