Obesity is a growing global concern, with a significant rise in obesity-related health conditions. While bariatric surgery remains a key strategy for treating obesity, more options are emerging for managing this disease. An intragastric balloon is a non-surgical procedure designed to assist adult patients in losing and maintaining weight. This article provides a detailed overview of the intragastric balloon procedure, including its benefits, risks, preparation, and what to expect during and after the procedure.
What is an Intragastric Balloon?
An endoscopic weight loss procedure is a non-surgical approach that uses an endoscope for your weight loss treatment, instead of external incisions (cuts). The intragastric balloon is a soft, smooth, durable silicone balloon that’s about the size of a grapefruit or a softball. Intragastric balloon placement is a weight-loss procedure that involves placing a saline-filled silicone balloon in your stomach. When placed in your stomach, the balloon limits the amount of food you can eat and makes you feel full faster. This helps you lose weight by limiting how much you can eat and making you feel full faster.
The intragastric balloon takes up space within the stomach, limiting the amount of food a patient can consume at any given meal. It reinforces proper portion control and helps you eat smaller portions. The balloon is filled with saltwater and can stay in the stomach for six months.
Why is it Done?
The placement of an intragastric balloon helps you lose weight. Intragastric balloons aren't the right choice for everyone who is overweight. The intragastric balloon procedure is designed for patients who are not morbidly obese, but also may not be able to undergo bariatric surgery.
Clinical studies of the intragastric balloon indicate it can help patients lose more weight than with diet or exercise. Studies on this weight loss strategy indicate that patients who receive intragastric balloon coupled with behavior modifications such as improved diet and exercise can lose over two times as much weight after 12 months than people who simply follow behavior modifications. Patients lost about three times more weight than those using diet and exercise alone.
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Who is a Good Candidate?
To qualify for intragastric balloons, you need a body mass index (BMI) of between 30 and 40. Healthcare professionals use BMI to determine your health risk for weight-related diseases. A BMI of 30 or above is a sign of obesity. While it’s not a perfect method, BMI can be a useful health indicator for many people. Balloons are not appropriate for all patients.
Indications in the USA include a BMI of 30 to 35 kg/m2 but a BMI of 27 to 35 kg/m2 in Europe. In Europe, a patient with a BMI of 27 to 35 kg/m2, or in the United States with a BMI of 30 to 35 kg/m2, an intragastric balloon can be considered an early intervention therapy to induce weight loss. These patients do not meet the eligibility criteria to undergo bariatric operations, but early intervention would benefit from preventing or even treating obesity-related illnesses.
What Happens Before the Procedure?
We like to see patients a few weeks before the treatment in order to describe the procedure in detail and answer any questions you may have. You’ll consult with your healthcare provider to determine if you’re a good fit for the intragastric balloon system. If you are, your healthcare provider will assemble a team of caregivers to support you through the program. You’ll consult with a nutritionist, gastroenterologist, psychologist/psychiatrist and possibly others to design a personalized weight loss program.
We also may start patients on a medication called a proton pump inhibitor. This medicine lowers the amount of acid in the stomach and helps prepare the stomach for the balloon. A healthcare provider will explain the risks, benefits and alternatives to the procedure and obtain your informed consent to proceed. They’ll often start you on acid-blocking medication to prevent acid reflux during and after the procedure. A few days before the procedure, they’ll put you on a clear liquid diet to help empty your stomach. The night before, they’ll ask you not to eat and drink anything after midnight.
How is the Procedure Performed?
During the procedure, a thin tube called a catheter is moved down your throat and into your stomach. The intragastric balloon is inside the catheter. Next, the doctor advances an endoscope - a flexible tube with a camera attached - down your throat and into your stomach.
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While you’re sedated, the balloon is placed into stomach using an endoscope. The team with the Endoscopic Weight Loss Program offers innovative weight loss procedures that do not require invasive surgery. You are sedated, so you are very sleepy and comfortable. The intragastric balloon procedure is done in the endoscopy unit as an outpatient procedure. Most people have this procedure while awake, but with a mild sedative.
Once the balloon is placed in the stomach, it’s filled with saline. The Orbera balloon is filled with a sterile, saline solution, as most models are. The filled Orbera balloon takes up about a third of your stomach. The weight of the fluid makes it sink to the bottom, which is part of how it works. It slows down the emptying of your stomach through the valve at the bottom (pylorus).
This process usually only takes about 15 minutes. The procedure itself takes 20 to 30 minutes. After treatment with the balloon, patients wake up and go home that same day. You will be able to go home as soon as the sedation wears off.
What to Expect After the Procedure
The recovery period is generally only a couple of hours in the endoscopy recovery room. You may receive some IV fluids (fluids given through a vein) and antiemetics (anti-nausea medicines).
You can have small amounts of clear liquids starting about six hours after the procedure. You will be on some dietary restrictions following the procedure. You first follow a full liquid meal plan, which includes protein shakes and similar products. You then transition to a soft food plan (including easy-to-eat foods, like oatmeal, bananas and soft-cooked rice). For the first two weeks after gastric balloon insertion, you will be on a liquid diet, followed by a gradual transition to regular food.
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You might experience some nausea, vomiting or stomach cramping for a few days after the balloon is placed in your stomach. Your doctor will prescribe medications to help with these symptoms, which tend to go away in three to five days. Reflux or gastroesophageal reflux disease (GERD) symptoms can be worse after balloon placement but can be improved with a daily antacid medication such as a proton pump inhibitor (PPI).
Your stomach will need time to adapt to the balloon before you resume your regular diet. You’ll start with a liquid diet and gradually advance to pureed foods, followed by a soft diet, and finally, the long-term diet designed by your nutritionist. You’ll stay in close contact with your healthcare team during this time. They’ll support you through the physical and psychological side effects while you’re adjusting.
How Long Does the Balloon Stay In?
Intragastric balloons are left in place for up to six months and are then removed using an endoscope. The weight loss balloon is designed to stay in your stomach for six months. The Orbera balloon stays in place for six months. During this time, you’ll continue to work with your team to make the diet and lifestyle changes that will sustain your weight loss over the long term. You’ll eat less, lose weight and retrain yourself to notice when you’re getting full. You’ll continue acid-blocking and anti-nausea medications as needed. The greatest weight loss happens in the first three months.
How is the Balloon Removed?
You’ll have a second endoscopic procedure to remove the balloon. When you have completed the treatment program or when your doctor recommends, the balloon can be removed. You’ll be given a sedative and a topical anesthetic or lubricant in your throat to ease the removal. Your endoscopist will puncture the balloon, suction out its filling and then withdraw the deflated balloon.
What Happens After Balloon Removal?
After the balloon is removed, the next step is an additional 6 months of medically supervised weight loss. We also provide support after the operation. We take a collaborative approach to treatment that combines the expertise of many different specialists.
Potential Risks
Pain and nausea affect about one-third of people soon after insertion of an intragastric balloon. Although rare, serious side effects may occur after intragastric balloon placement. A potential risk includes balloon deflation. If the balloon deflates, there's also a risk that it could move through your digestive system. Other possible risks include overinflation, acute pancreatitis, ulcers or a hole in the stomach wall, called a perforation.
Expected Results
An intragastric balloon can make you feel full faster than you normally would when eating, which often means you'll eat less. One reason why may be that the intragastric balloon slows down the time it takes to empty the stomach. You are likely to lose weight quickly, especially in the first three to four months of living with the gastric balloon.
You might experience better health, like improvements in weight-related health conditions. These can include sleep apnea, high blood pressure, type 2 diabetes, fatty liver and dyslipidemia. Dyslipidemia is when you have abnormal amounts of lipids (fats) in your blood.
When Weight-Loss Procedures Don't Work
It's possible to not lose significant weight or to regain weight after any type of weight-loss procedure or surgery, even if the procedure itself works correctly. This weight gain can happen if you don't follow the recommended lifestyle changes.
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