The Gastric Balloon: ( Intragastric Balloon)
The gastric balloon is a non-surgical weight loss procedure and has emerged as a boon for this section of overweight, class 1 and class 2 obese people who have tried exercising, dieting, lifestyle modifications, and failed in managing their weight, and for those who are not good candidates or do not wish to undergo weight loss surgery. However even though it is a simple procedure, one needs to be eligible to have the gastric balloon. A prior endoscopy is essential before the balloon procedure and it should be normal to ensure safe placement of the intra gastric balloon.
Procedure: The gastric balloon is a medical device made up of silicone and inserted into the stomach endoscopically in a deflated state. The balloon is then inflated with saline and methylene blue and dislodged in the stomach where it stays for six months to a year or more before removing.
The balloon inflation should be adequate enough to achieve its purpose of weight loss and avoid the risk of it passing through the pylorus. The methylene dye is used to alert the patients for any leak of the saline from the balloon which could occur and will be noticed as a blue colour in the urine. This needs to be informed to the doctor immediately, so that necessary intervention and removal of balloon can be made to avoid complications.The entire process may take upto 30 minutes and is done under sedation/ anaesthesia.
Mechanism of achieving goal: As the normal gastric volume is around 900ml approximately, the gastric balloon may be inflated upto 500 to 550 ml in order to occupy space in the stomach to induce fullness or satiety, reduce hunger bouts and intake of food, and delay gastric emptying ( process of moving the contents of the stomach into the duodenum for further absorbtion). These factors form the cornerstone of weight shedding, the main objective of the Gastric Balloon procedure.
The Gastric Balloon comes in three types.
- Endoscopic Non adjustable Intragastric Balloon: A balloon inserted endoscopically which can stay in the stomach for a period of 6 months( during which weight loss is to be achieved)and then is removed endoscopically.
- Endoscopic Adjustable Intragastric Balloon: As the name suggests, the balloon is adjustable, which means that the size of the balloon after placing it in the stomach endoscopically, can be increased when further weight loss is required by increasing the restriction of food intake. Similarly, if the person feels uncomfortable after the balloon procedure with the amount of saline inflated, removal of a few ml of saline can make the person comfortable. This adjustment is done endoscopically by the doctor
- Non-Endoscopic Intragastric Balloon: The non-endoscopic gastric balloon, comes in the form of a capsule which has to be swallowed for placement in the stomach. Once inside the stomach and position is confirmed radiographically by the C arm, it is inflated with saline and dislodged from the source. It stays in the stomach in the inflated condition for a period of four months after which it empties by itself and is naturally excreted.
Post Procedural care: The individual may experience teething problems including cramps and nausea in the stomach till it adjusts with the inflated gastric balloon, A liquid or soft diet for a couple of weeks followed by embracing healthy diets may exhibit promising results.
Safety: The gastric balloon is very safe and rarely encounters any complications. The risks that are only presumed to occur are esophageal ulcers or perforation as part of procedure complications, rupture of balloon causing the dye to release in the urine, or deflation of the balloon leading to blockage in the intestine.
Important message: The balloon is a beautiful device and if it has to stay as a weight loss procedure, it has to be used very deligently.
- Selection of the right candidate for the balloon is paramount.
- Expectations should be realistic, as the balloon has its limitations
3) For best results, the intragastric balloon has to be accompanied by lifestyle modifications in terms of diet and exercise.
4)It would be unfair to expect the same results from the intragstric balloon that we expect from a bariatric procedure in a morbidly obese person.