Dr.Weight // Bariatric surgery // Intragastric balloon for loss of excessive weight

Intragastric balloon

Intragastric balloon for loss of excessive weight

Bariatric Surgery - DoctorWeight.com – 2008

The use of an intragastric balloon is a non-surgical and ‘conservative’ method of weight reduction. Made of high-quality soft medical silicone, the balloon itself is a thin smooth elastic ball inflated by valve with 500 cc of water (to a diameter of 13cm).

How it works

The presence of the balloon in the stomach reduces its internal volume and therefore the amount of food it can hold. At the same time, it distends the gastric wall and causes the receptors there to send to the brain a signal of satiety.

How long can the balloon stay in the stomach?

Six months is recommended, after which removal is necessary as gastric acid gradually destroys the silicone shell of the balloon. (Barring technical defects, it normally survives that period.) A new one may be inserted during the same procedure if such is the patient’s wish.

Eligibility

The technique is best suited to patients with a BMI (Body Mass Index) from 30 to 40 who, as a rule, have already exhausted other conservative methods of weight loss such as diets, physical exercise, psychological assistance, and even tablets and food supplements.

It also presents a viable temporary option to patients with BMI 40+ who are ruled out of bariatric surgery under general anaesthesia on account of poor health (e.g. serious heart and lung problems). By enabling them to reduce weight and improve their general condition, it facilitates subsequent major surgery.

Precluding factors

Balloon placement is a medical procedure and not performed for cosmetic reasons. Patients with BMI of less than 30 are ineligible except in special cases.

Other precluding factors are:

• Inflammation of digestive tract, e.g., oesophagitis, stomach and duodenal ulcers, Crohn’s disease
• Digestive malignancy
• Evidence of potential sources of bleeding in the digestive tract, e.g., varicose oesophageal veins and teleangiectasias.
• Large oesophageal hernias and severe Gastroesophageal Reflux Disease
• Throat and oesophageal strictures and diverticula
• Other medical conditions preventing upper GI tract gastroscopy
• Serious mental disorders, alcoholism and/or drug dependence
• Lack of self-discipline causing failure to comply with a doctor’s recommendations
• Regular use of aspirin, other anti-inflammatory drugs, steroids and anticoagulants
• Pregnancy and lactation

Method of installation

Although balloon installation is not an operation but an endoscopic procedure, it is usually performed under general anaesthesia. The balloon is inserted empty into the stomach through the mouth and the oesophagus. Its correct position is confirmed by endoscopy; an inflation system is attached and saline solution added. After complete inflation (usually 500 cc) the catheter is removed from the balloon valve, which automatically closes.

How to live with the balloon

While the patient may go home after a few hours, we recommend staying overnight as unfortunately the first night after balloon placement can be unpleasant with strong nausea and vomiting. If the patient stays in hospital, we can help him/her with injections of nausea-reducing drugs or intravenous infusion of saline for rehydration.

In most cases these effects diminish gradually over 3-4 days. The patient is advised to take drugs such as omeprazole to reduce stomach acid. A strict diet is not essential during balloon treatment, but best results are achieved with a daily caloric intake of 1000-1500 kcal.

How weight loss occurs

Weight reduction begins immediately and proceeds as follows (mean data based on several clinical studies):

• Weight loss up to 40 kg
• Mean weight loss 15 kg
• Excess weight loss 40%

BMI decrease 5 kg/m2

Diet Patients who adhered to a diet of 1000-1500 kcal/day lost an average of 18 kg; those who did not managed only 9.6 kg. Thus the balloon helps those who help themselves, since the usual weight loss principles still apply: avoid carbohydrates and fats, and reduce general caloric intake.

Balloon removal

At the end of the 6-month period the balloon must be removed, though if a patient does not tolerate the balloon well it is removed earlier.

The patient comes to the procedure on an empty stomach and is placed under general anaesthesia. A doctor inspects the stomach and the balloon with a flexible endoscope. The balloon is punctured with a needle, and the fluid is aspirated. The empty balloon is then trapped by a special loop and gently removed from the stomach. After 2-3 hours the patient may go home.

Complications

Every kind of treatment has its own possible problems. Fortunately, they are not in this case life-threatening.

• Balloon intolerance (5-7% of patients). Symptoms are permanent nausea and vomiting, and sometimes pain. If this can not be adequately relieved, the balloon must be removed.
• Rarely (1%) there can be erosion and ulceration of the stomach, mostly if the patient ignores the instruction to take omeprazole.
• Spontaneous rupture of the balloon (2%). This is manifested in green colouration of the urine. The fact is that we purposely add blue medical dye (methylene blue) to the water during balloon inflation, so that if the integrity of the balloon is compromised the dye is absorbed in the intestine and then discharged with the consequently discoloured urine. Generally it is not dangerous, as the empty balloon usually moves along the intestinal tract and is naturally excreted by bowel movement. Nevertheless, cases have been documented of intestinal obstruction by a ruptured balloon, meaning that in case of balloon leakage the patient must inform his/her doctor urgently. The doctor decides whether to remove the leaking balloon or to await its natural evacuation.
• Insufficient or negligible weight loss. This becomes more probable if the patient fails to follow therapeutic recommendations.
• Feeling of excessive heaviness in the stomach.
• Heartburn.

Other complications connected with general anaesthesia and endoscopy.

Can the weight come back after balloon removal?

This mostly depends on the patient. If the patient returns to his/her previous eating habits, the weight is sure to return. Unfortunately, this is precisely what occurs in more than half of all cases.

• Operations aimed at decreasing absorption of nutrients in the digestive tract
• Operations aimed at narrowing the stomach
• Operations aimed at reducing appetite
• Intragastric balloon for loss of excessive weight