Gastric Balloon - Indications, Procedure, and Outcome

Introduction:

The intragastric balloon is also called a gastric balloon or a stomach balloon. It is a weight management procedure recommended for obese people whose BMI (body mass index) is between 30 and 40. It involves placing a deflated silicone balloon into the stomach and then filling it with saline guided by an endoscope.

What Is a Gastric Balloon?

A gastric balloon technique is used in obese people who have failed to lose weight with dieting and exercise, who are not the right candidate for other invasive weight loss procedures, or who do not prefer invasive bariatric techniques.

The balloon used is a silicone elastomer-based material. In addition, this silicone balloon is deflated and placed inside the stomach. As a result, the balloon occupies one-third capacity of the stomach and gives a satiated feeling sooner. Also, delayed gastric emptying promoted weight loss with this technique.

What Are the Indications?

• BMI between 30 and 40.

• To prevent co-morbid conditions like heart disease.

• Stroke.

• High blood pressure.

• Type 1 diabetes mellitus.

• Obstructive sleep apnea.

• Non-alcoholic fatty liver disease.

• Heart disease.

• Patients who cannot undergo surgical bariatric procedures like adjustable gastric banding, sleeve gastrectomy, and Roue-en-Y gastric bypass surgery.

• People who do not prefer invasive bariatric procedures.

How Is It Performed?

A gastric balloon is not suitable for all obese people; hence, a few screening tests will be performed to decide if this procedure will be beneficial to the patient. Also, a few laboratory tests like HbA1c, hemogram, random blood sugar, serum calcium, serum magnesium, serum cortisol, and HBsAg will be performed to rule out any other complications.

Other tests like HIV (human immunodeficiency virus) I and II, anti-HCV (hepatitis C virus), urine analysis, C-peptide fasting, and GAD antibodies (glutamic acid decarboxylase) are done. In addition, imaging studies like ECG (electrocardiography), ultrasound abdomen, DEXA (dual-energy X-ray absorptiometry) scan, and chest X-rays are done.

Before starting the procedure, there will be diet and fluid restrictions, and also, engaging in physical activity will be encouraged.

• Procedure:

  • An endoscopic technique, where a thin, flexible tube (an endoscope) with a light and a camera is attached to one end of the tube and is inserted into the stomach through the mouth. The other end of the tube will be connected to a monitor outside.

  • Before the procedure starts, the patient is sedated. Then, a flimsy compressible catheter with a deflated balloon is inserted into the mouth, which is advanced to the stomach.

  • An endoscope is inserted similarly, and with the help of the endoscope, the inner view of the stomach is viewed on the monitor outside, and saline, which is colored in blue (to differentiate between the bodily fluids if it leaks into the abdomen), is injected into the deflated balloon. Once the deflated balloon is filled to the desired level (up to 400 milliliters), the endoscope and the catheter are removed. The gastric balloon is self-sealing and moves freely in the stomach after the procedure. Sometimes, instead of colored saline, air will also be used to inflate the balloon.

  • The stomach's capacity is that it can hold 1200 ml. But in an obese person, the stomach can stretch up to three times the average volume since the intragastric balloon is a space-occupying device and induces a satiated feeling, which promotes weight loss.

  • Also, delayed gastric emptying is achieved with this process, which gives a satiated feeling for a long time, promoting weight loss.

  • However, this is a temporary and minimally invasive procedure.

What Are the Instructions to Be Followed After the Procedure?

• After six hours of the procedure, clear fluids can be consumed.

• This needs to be followed for two weeks.

• By the end of two weeks, soft solid foods can be started.

• By the third week, normal foods can be consumed.

• Engage in physical activities like regular exercise and dietary modifications.

• Since this is a temporary procedure, the balloon will be removed after six months. After that, depending on the need and the doctor's advice, another balloon may be replaced after consultation with a nutritionist and psychologist.

What Are the Outcomes?

• Feeling full sooner due to limited stomach capacity for food accommodation. But this is not applicable when the diet includes liquids only. However, there are beneficial results with solids.

• Eating less, both of which promote weight loss.

• Delayed gastric emptying.

• This procedure alters the hormone ghrelin's reaction. It is a hormone that stimulates appetite, carbohydrate metabolism, and energy homeostasis. Also, it stimulates intestinal and gastric motility.

• Also, effective weight loss depends on being consistent with physical exercise and diet.

• And there is about seven percent to 15 percent effective weight loss in the first six months. After that, total excess weight loss ranges between 30 percent and 47 percent.

• It helps reduce the severity or resolve heart conditions, lowers blood pressure, GERD (gastroesophageal reflux disease), obstructive sleep apnea, osteoarthritis, lowers cholesterol levels, type 2 diabetes, and non-alcoholic fatty liver disease.

What Are the Risks?

• Pain and nausea, however, resolve in a few days. In addition, they can be managed with medications.

• Overinflation.

• Pancreatitis.

• Perforations in the gastric wall (stomach wall).

• Early deflation of the intragastric balloon. It can also descend into the digestive tract and may result in blockage.

• Rarely, nausea and vomiting associated with abdominal pain may also occur. Visiting a nearby hospital for immediate care is advisable if these symptoms develop.

Under Which Condition Are Gastric Balloons Removed?

• When there is adequate weight loss.

• After a period of six to eight months.

• If the patient does not tolerate the balloon placement.

• When there is spontaneous rupture.

Conclusion:

The intragastric balloon, also called a gastric balloon, is an excellent weight reduction method in overweight people with BMI between 30 and 40. Though this is a temporary procedure, it serves a good purpose. In addition, the positive outcomes are more than complications. Also, the complications are not fatal but cause nausea, vomiting, and abdominal pain, which can be managed immediately by visiting a doctor. However, lifestyle changes and engaging in physical activity will aid weight loss in association with this bariatric procedure.