The Gastric Balloon treatment for obesity (Non surgical)
A gastric balloon is ideal for patients with obesity problems who have tried many alternative ways to lose weight, but would prefer to avoid surgery.
It is a balloon that is inserted into the stomach (with the help of Gastroscope) and inflated, thus reducing stomach capacity and the amount of food a person can comfortably eat. This procedure is carried out with mild sedation and patient are allowed home 1 hours after the procedure.
Many people have tried a wide variety of diets and weight-loss programmes without success, but are not willing to consider a surgical intervention. If you are one of these people, you are probably feeling trapped. You don’t want to go on doing what you have always done – because it doesn’t work – but you feel you need a “kick start” which doesn’t involve surgery. If you find yourself in this position, the gastric balloon may be a safe and effective option for you.
There are several types of gastric balloon available. we use the most thoroughly researched and tested form of the device - the BioEnterics Intragastric Balloon (BIB™). In what follows, we use the terms gastric balloon and BIB™ interchangeably.
What is the BIB™?
The gastric balloon is a soft, silicone balloon that is inserted into the stomach and filled with sterile saline (salt water). When the balloon is filled it stretches the stomach wall producing a feeling of satiety – or fullness. In addition, because the balloon fills a significant portion of the stomach, it means that you have to stick to much smaller portion sizes – which means less calories!
How is the balloon implanted?
Placing the BIB™ in the stomach is a simple procedure which will take approximately 20-30 minutes and which will be carried out under light sedation by a Consultant Gastroenterologist.
The doctor passes a special endoscope (camera) through the mouth, down the oesophagus (gullet) and into the stomach. A preliminary examination of the stomach is carried out and, assuming there are no abnormalities, the BIB™ will then be passed into the stomach. The balloon is made of a soft and pliable silicone elastomer material and is inserted while in its smallest, deflated form. The swallowing process is made easier with the help of some local anaesthetics to help numb the throat area. Muscle relaxing medications are also used.
Once the balloon is inside the stomach, it is immediately filled with sterile saline through a small filling tube (catheter) attached to the balloon. Once filled, the doctor removes the catheter by gently pulling on the external end. The balloon has a self-sealing valve, and at this point the balloon is floating freely in the stomach. At the same time, a special dye is introduced into the balloon which will cause your urine to change colour (usually blue) in the very unlikely event that the balloon ruptured or developed a leak.
Because there is no general anaesthesia involved, you will normally be able to leave hospital after a few hours of observation. .
Adjusting to the balloon
For the first few days you will feel uncomfortable as your stomach adjusts to the presence of the BIB™. During this time you may experience nausea, vomiting, bloating and some cramping until your body adjusts. Thereafter your symptoms should decrease, allowing you to settle into your concentrated weight loss period of around 6 months.
What are the risks?
The procedure itself is simple and serious complications are uncommon. In the scientific literature reported complications include:
· If the BIB™ ruptured it will usually pass through through the bowel and be expelled quite naturally. However, in rare cases it may cause intestinal obstruction (blockage of the bowel). If this occurs, surgical or endoscopic removal would be required
· Bleeding or perforation of the oesophagus or stomach could occur during the balloon insertion or removal, requiring surgical correction.
Gastric discomfort; nausea and vomiting are common for the first few days following balloon placement. A feeling of heaviness in the abdomen, abdominal or back pain, gastro–oesophageal reflux or indigestion have also been reported.
In one of the largest published studies of the gastric balloon (BIB)1 involving 2,515 patients, the authors reported the following:
Implanting the BIB was uneventful in 99.9% of cases
Overall complication rate was 2.8%, consisting of:
Gastric perforation in 5 (0.19%) cases
Rupture of the balloon in 9 (0.36%)
Inflammation of the oesophagus occurred in 32 (1.27%)
Gastric obstructions in 19 (0.76%)
Gastric ulcer in 5 (0.2%)
There were only 2 (0.08%) deaths (occurred in patient previous major abdominal surgery, hence we exclude patients with past of major abdominal surgery)
These results confirm that the balloon is a very safe intervention for the overwhelming majority of patients.
How long does the balloon stay in?
The balloon can stay in place for a maximum of 6 months, though most of the weight loss occurs in the first 4 months. At the end of the 6-month period, the balloon will be removed in a 20-minute procedure similar to that of the placement.
How is the BIB™ removed?
After 6 months the BIB is removed through the mouth in the same way that it was introduced into the stomach. The removal procedure is again performed under light sedation.
How much weight will I lose?
Patients who have the gastric balloon implanted can expect to lose around 35-40% of excess weight, which in most cases equates to around 30-50lbs (15-20kg)2,3 Heavier patients may lose substantially more than this.
What are the health benefits?
The health benefits of the BIB™ are those associated with any method of weight loss, including an improvement in diabetes, hypertension (raised blood pressure) , arthritic symptoms and sleep apnoea4. There are also major improvements in mobility and self-esteem.
What are the long-term benefits?
A recently published study looked at what happens to BIB patients one-year after the balloon was removed5. At the time of removal of the BIB, average weight loss for the 100 patients in the study was 12 kg (40% excess weight). One year later, mean weight loss was 8.6 kg (26% of excess weight). A further study of 140 patients with a follow-up of up to 30 months, found that 40% of patients maintained a weight loss of 25% excess weight or above6.
Taken together these results are encouraging and serve to make the very important point that long-term success with the gastric balloon depends upon a genuine commitment to making - and sustaining - significant lifestyle changes.
Am I suitable for a balloon?
There are three groups of patients who may benefit from the BIB.
1. BMI 28-30 Kg/m2
Many people have attempted to lose weight on conventional diets without success. If you are in this group and your BMI is only 28-30kg/m2 (calculate your BMI ) you are not suitable for surgical treatment with a gastric band or bypass. However, the BIB™ may be an excellent alternative. In practical terms it lies midway between a conventional weight-loss programme and a true surgical intervention. It is clearly something more than a diet, but at the same time it falls well short of being a surgical procedure. It facilitates rapid weight loss safely and effectively, without the risk of general anaesthesia.
Can we mention about the waist line?
2. BMI greater than 30kg/m2
If you have a BMI above 30 kg/m2 and you have decided against the usual surgical options for which you may be eligible (gastric band, bypass etc), the BIB™ may be an acceptable and effective alternative. So if you definitely don’t want surgery but have reached the point where standard approaches to weight loss just don’t work, a gastric balloon might be the next step.
3. BMI greater than 50kg/m2 and/or co-morbidities
If you have a major weight problem with a BMI above 50 kg/m2 and/or medical problems such as diabetes, heart and lung problems etc, you may not be suitable for standard weight-loss surgical procedures which involve general anaesthesia. In this case a BIB™ may be a safe and effective first option. Losing weight with the gastric balloon will improve your physical functioning and reduce your anaesthetic risks, so that if you do then decide to go ahead and have a gastric band or a gastric bypass, the operative risks will be much less.
When is a balloon not suitable?
In some cases a gastric balloon is not a suitable option due to a current or past medical or surgical condition, or because of long-term treatment with certain classes of drugs. The following list is not comprehensive, but lists the most important potential contra-indications for a gastric balloon.
· A large hiatus hernia
· Previous anti-obesity surgery such as gastric banding or bypass
· Previous upper gastrointestinal surgery of any kind
· Strictures (narrowing) of the oesophagus (gullet)
· Inflammatory disease of the upper gastrointestinal tract (Crohn’s disease)
· Currently under treatment for cancer
· Conditions or drugs that predispose you to bleeding
· Long-term treatment with certain drugs, such as aspirin and non-steroidal anti-inflammatory drugs (NSAID’s)
· Long term steroid therapy
· Severe heart, kidney, liver or lung disease.
· Certain psychiatric disorders
· History of alcoholism or drug addiction
Women who are pregnant or breast-feeding
If you have any of the above or some other condition, please telephone Healthier Weight for more advice.
What about age limits/
In general we do not apply rigid age limits to our eligibility criteria. If you do not have any of the exclusion criteria referred to above and you have a BMI of 28 kg/m2 or above, you are probably eligible for a BIB™.
What about children?
We do not usually offer the gastric balloon for the treatment of children or adolescents. This is because there are no published data to support its use in these groups. To our knowledge, only one study has reported on the use of the gastric balloon in adolescents. A total of five adolescents (11-17 years old) were included in the trial, all of whom were heavier at the end of the trial than at the beginning. The authors concluded that gastric balloons are probably not indicated for the treatment of obesity in children and adolescents7.
What do I do now?
If you are interested in the gastric balloon and would like to find our more or make an appointment for a consultation, please contact the Healthier Weight Centre.
Some guidelines after the placement of an intragastric balloon (Bioenterics® Intragastric Balloon or BIB® system) by endoscopy in order to assist with weight loss
The placement of an intragastric balloon is a non-surgical, non-pharmaceutical and totally reversible method. The empty balloon is inserted into the stomach by endoscopy and then filled with water or sterile saline. It takes up one third of the stomach reservoir, leading at first to a feeling of fullness, and from then on to a reduction of food intake and weight loss. The balloon will remain in the stomach for about 6 months and the patient will be conditioned to adopt good dieting habits.
The first days after placement, the patient will very likely suffer from stomach ache, nausea and vomiting for more or less one week.
For a transitional period before starting the usual low-calorie diet, a few measures will be advised as follows:
For the first few days ensure an adequate and very fragmented oral hydration. The diet is only liquid at the beginning. Beverages are divided up in small quantities throughout the day: 50-100 ml at a time at intervals. The patient will be able to drink water and low-calorie juices. The best food however is skimmed milk which can hydrate and feed him in proteins while bringing few calories. Orange juice can be a good supplement to milk owing to its potassium content which can compensate for potassium deficit caused by vomiting. Salted stock can also be useful to prevent dehydration after vomiting. The first kilos are actually lost partly by dehydration related to fasting and vomiting.
After a few days the patient will be able to take gruels, stewed fruit and thicker soups.
Finally, if his/her tolerance is all right, he or she could reintroduce solids provided he/she masticates the food properly.
The diet will be progressive: 1200 cal a day to begin with, then 1000 cal and finally 800 cal depending on the physical activities.
A vitamin supplement will be prescribed to the patient in order to make up for a potential vitamin deficit due to the diet. In that way we hope to make the patient lose on an average between 10 and 20% of the initial weight in 6 months
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