Gastric Balloon - Indications, Procedure, and Outcome

Introduction:

The intragastric balloon, also called a gastric balloon or a stomach balloon, 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 made of 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. It is a good option for those who are looking for a non-surgical weight loss solution.

What Are the Indications of Gastric Balloon?

The indications of the gastric balloon are as follows:

• BMI between 30 and 40.

• To prevent co-morbid conditions like heart disease.

• Stroke.

• High blood pressure.

• Type 1 diabetes mellitus.

• Obstructive sleep apnea (breathing pauses during sleep).

• Non-alcoholic fatty liver disease (build-up of fat in the liver).

• Heart disease.

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

• People who do not prefer invasive bariatric procedures.

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.

How Gastric Balloon Is 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 engaging in physical activity will be encouraged.

Procedure:

• An endoscopic technique involves a thin, flexible tube (an endoscope) with a light and camera attached to one end. The tube is inserted into the stomach through the mouth, and the other end is 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 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 1200 ml. However, in an obese person, the stomach can stretch up to three times the average volume since the intragastric balloon is a space-occupying device that 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 and promotes weight loss. However, this is a temporary and minimally invasive procedure.

What Are the Instructions to Be Followed After Gastric Balloon?

The instructions that are to be followed after the gastric balloon process are as follows:

• 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 of Gastric Balloon?

The outcomes of the gastric balloon are as follows:

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

• Eating less promotes weight loss.

• Delayed gastric emptying.

• This procedure alters the reaction of the hormone ghrelin. Ghrelin stimulates appetite, carbohydrate metabolism, and energy homeostasis. It also stimulates intestinal and gastric motility.

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

• And there is about seven to 15 percent effective weight loss in the first six months. After that, total excess weight loss ranges between 30 to 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 Benefits of Gastric Balloon?

The benefits of the gastric balloon are as follows:

• It is a non-surgical and minimally invasive technique.

• It is effective for weight loss.

• It lowers the risk of complications, such as infection, bleeding, and long-term deficiencies.

• Recovery time is minimal.

What Are the Risks of Gastric Balloon?

The risks of the gastric balloon are as follows:

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

• Overinflation (containing too much air).

• Pancreatitis (pancreas inflammation).

• 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.

Conclusion:

The intragastric balloon, also called a gastric balloon, is an excellent weight reduction method in overweight people with a 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.