What is Intragastric Balloon?
Endoscopic intragastric balloon or briefly gastric balloon is a relatively new and non-surgical bariatric treatment procedure. It has been developed with intent to fill the gap between dieting and exercising only and undergoing more complicated bariatric surgical procedures.
It is an applicable non-surgical obesity treatment, the use of which is known all over the world. The idea of controlling obesity by giving a sensation of satiety with the help of a gastric space-occupying balloon was first developed in 1982. It has been proven by hundreds of studies that since then weight loss could be achieved successfully with many different types of balloon. In the mid 1980’s, balloon use was interrupted for a certain period of time, due to poorly designed and produced balloons that spontaneously deflated and led to intestinal obstruction.
At a scientific congress held in 1987 in Florida, a great number of international experts came together and determined the basic design criteria for an ideal gastric balloon. The new-generation intragastric balloons have become a well-accepted treatment procedure all over Europe. Properties that a good balloon must have:
– It should be produced from high quality silicone elastomer to ensure it to be resistant to gastric acid and sharp parts of foods.
-It should be filled with serum.
-It should be spherical and smooth surfaced, having a low potential to cause ulcer and obstructions.
-It should contain a radiopaque marker for a proper follow-up.
– Its volume should be between 400 and 500 cc, adjusted in accordance with the anatomy.
How is the Intragastric Balloon Placed?
The intragastric balloon is placed into the stomach with the help of a lighted camera called an endoscope. This device has an average thickness of 0.8-12 mm and its flexibility is adequate to allow it to easily pass through the esophagus. The patient is enabled to totally sleep for a period of 10 to 15 minutes without respiratory standstill by means of the conscious sedation technique called sedoanalgesia, applied by the anesthesiologist during the procedure. In other words, it is impossible for you to feel anything during the procedure and remember anything after it.
After the anesthetization of the patient, first a complete endoscopic examination is performed. In other words, the entire upper digestive system from the esophagus to the duodenum is examined. If any reflux, ulcer, severe gastritis or suspicious lesion is not observed in the stomach, the endoscope is removed and then the balloon is placed into the stomach. Afterwards, the balloon is gradually inflated while the site is being observed through the endoscope. Physiological saline solution that contains an ink-like coloring agent called ‘methylene blue’ is used to inflate the balloon It is intended for enabling the patient to notice its color in the urine or stool in case of any leak from the balloon, and go for an examination. The entire procedure takes about 10 minutes. After that, the patient immediately regains consciousness. He/she can leave the hospital after taking a 1-2 hour rest. No discomfort is felt in the early postoperative period. After a few hours, certain symptoms such as stomach cramps, nausea and vomiting may be encountered.
These side effects are related to the mass effect that the balloon creates on the stomach, and they usually last for a period not exceeding 3-4 days. In this process, symptoms are alleviated by means of medications administered orally or intravenously. Very rarely, if the patient cannot consume adequate amount of fluid, an intravenous supplementation with serum may be required. In most patients, complaints completely disappear at the end of the first week. Very rarely, the balloon needs to be removed earlier, in cases where the symptoms do not get alleviated and the balloon cannot be tolerated despite all the treatment procedures.
How is the Intragastric Balloon Removed?
At the end of the 6-month period, the balloon is removed with an endoscopic method again. First, the liquid in the balloon is drained by means of a special apparatus, and then the balloon is caught and removed by a special holder. The reason for why we state this is to indicate the fact that the instruments available in a standard endoscopy unit will not work in the balloon removal process. In our individual practices, we had a patient whose balloon has been punctured in another endoscopy center and since it could not be removed, then led to an intestinal obstruction. Therefore, balloon placement and removal processes should be carried out by bariatric surgeons experienced in endoscopy.
Who are Eligible For Intragastric Balloon?
Stomach balloon is an alternative non-surgical treatment of obesity that does not involve medications. Cases where it is appropriate to use:
- Patients between the ages of 18 and 60
- Inoperable patients with a body mass index (BMI) of 30-39
- Patients with a body mass index (BMI) of 35 or greater, who need to be slimmed before surgery due to serious risks.
- Patients who have tried other methods and failed in the past.
- Those who have not certain problems in the digestive system, such as a big stomach hernia, esophageal varices, strictures, and ulcers.
- Women having no risk of being pregnant, who are also not likely to get pregnant for a period of 12 months.
- People without alcohol and drug addiction
- People who have no history of bariatric surgery, bowel obstruction or peritonitis.
- People who have no history of chronic high-dose painkillers or aspirin use
Who are not Eligible For Intragastric Balloon?
Patients with a body mass index (BMI) below 30: While this limit is applicable in the United States, cases with a BMI higher than 27 are eligible in Canada, Australia and the UK.
- Those with digestive system disorders such as esophagitis, gastric ulcer, duodenal ulcer, and Crohn’s disease.
- Those at the risk of upper digestive system hemorrhage associated with certain conditions such as esophagus or stomach varices.
- Those with congenital or acquired digestive system problems such as atresia or stricture.
- Mentally retarded or emotionally unstable people, and people with evident psychological problems.
- Alcohol and substance addicted people
- Those with a poor health profile making them ineligible for anesthesia (even for a mild anesthesia)
- Those with big a stomach hernia
- Those who have had abdominal surgery before.
What are the Risks and Complications of Intragastric Balloon?
Severe nausea may be encountered especially in the first days. Motilium and Primperan will alleviate these. Dehydration may occur due to inadequate fluid intake. At least 1 liter of physiological saline solution should be given. If the recommendations on postoperative fluid intake and diet cannot be followed, and if severe dehydration is develops, fluid-electrolyte replacement should be provided (during hospitalization if needed) The maximum working life of a balloon is 6 months. Methylene blue is used to detect any early deflation of the balloon. If there is a suspicion about the intactness of the balloon, a simple abdominal X-ray or ultrasound would be adequate. Intestinal obstruction is a very rare problem. It occurs if the deflation of the balloon is not noticed. New generation balloons are usually removed out of the body in the normal ways. However, intestinal obstruction may develop in rare cases.
What are the Results of Intragastric Balloon Procedure?
The balloon’s basic mechanism of action is to create a feeling of satiety and restrict food intake by means of its effect of partial space occupancy in the stomach. Choosing eligible patients and appropriate dietetics and behavioral therapy are the key points for the success of the balloon. However, weight loss cannot be guaranteed for any patient.
The most effective period of the balloon is the first 3-4 months. In this period, loss of appetite and discomfort during food intake are evident. It is essential to strictly comply with the nutrition program. A average weight loss of 15-20 kg can be expected. This limit may range from 0 to 80. Successful results have been reported from a great number of studies conducted on hundreds of patients in different countries such as Italy and the Netherlands.
Weight regain is possible after the removal of the balloon. Since it has no long-lasting or permanent effect, it could not find any area of use in certain countries. In cases where the patient does not change his/her eating habits, some problems can be encountered such as inadequate weight loss or not being unable to maintain the weight.
Further studies are needed for revealing the long-term consequences of intragastric balloon. It is essential to understand the fact that this is a repeatable non-surgical procedure that poses a low-risk, intended for providing support for changing eating habits. It is not sensible to expect all the effects from the balloon or present the balloon as a wonderful treatment.
Recommendations on Eating After the Placement of the Intragastric Balloon
- You must eat very slowly and by chewing well.
- It would be useful to eat foods divided into small pieces and served on small plates.
- You should stop eating as soon as you feel acid reflux or bloating.
- You should not eat more than three main meals and three snack meals a day.
- You should abstain from snacking.
- You should drink at least 1.5 liters of water per day.
- You should not drink water or have liquid foods when eating. You should not make a habit of drink before or after meals.
- Abstain from carbonated drinks and strong coffee.
- You should definitely not to smoke before meals.
- Do not eat too late at night.
- Stop eating and drinking at least 2 hours before going to bed.
- If you feel pain in our stomach, first change your lying position.
- Try to do exercise for at least 40 minutes a day.
- If you cannot recover from nausea and vomiting despite the medications, if you have a constant pain in your stomach, or if you notice blueness in your urine, contact us immediately.
How Much is the Cost of the Intragastric Balloon?
The average cost of intragastric balloon is 8,150 (600-10,000) dollars in the United States. It is 8,250 dollars in Australia, 5,800 dollars in Mexico and 6,195 dollars in the UK. The cost of the intragastric balloon at our center is much more affordable compared to these figures.