The technique of placing what is known as an 'intragastric balloon' in the stomach has become popular in the never-ending search for obesity solutions. But how safe is it? DietDoc takes a closer look.
Bariatric surgery which decreases food uptake by means of short-circuiting the digestive tract to reduce absorption of food to induce weight loss has been in use for many years. More recently, the technique of placing what is known as an “intragastric balloon” in the stomach and then inflating the balloon with liquid or air to reduce the size of the stomach and induce a feeling of satiety (fullness), has become popular in the never-ending search for obesity solutions.
What does intragastric ballooning involve?
Intragastric ballooning involves the insertion of a long tube (catheter) down the oesophagus into the stomach and placing the balloon in the stomach. The balloon is then filled with saline (physiological salt solution) so that it expands and creates a feeling of fullness in the stomach. Intragastric balloons are usually removed after 6 months by deflating the balloon and withdrawing it from the stomach. The salt solution in the balloon is coloured with a blue dye so that if the balloon should break or deflate, the patient will be alerted and can seek immediate medical assistance for the removal of the balloon. The latter precaution is important because a damaged balloon must be removed as soon as possible to prevent obstructions which can have very serious consequences and even cause fatalities (Timna et al, 2006; Dumonceau, 2008; Fernandes et al, 2009).
In some clinics, the balloon is filled with air (for example the Heliosphere Bag or Endogast), but according to Dumonceau (2008), the placement of air-filled intragastric balloons is more complicated because it requires a combined endoscopic and surgical insertion procedure.
Advantages of intragastric ballooning
Compared to having a gastric bypass operation or gastric banding, the procedure of intragastric ballooning has the following advantages:
- The technique is less invasive and generally does not require the patient to undergo surgery (unless the balloon is filled with air), or a full anaesthetic (mild sedation should be adequate)
- Patients usually do not have to stay in the hospital overnight and can return home on the day of the procedure
- The procedure is much less expensive because it does not involve anaesthetics or longer hospital stays
- The procedure is easily reversed
- Many patients do achieve satisfactory weight loss in the 6 month period during indwelling of the balloon, provided that they follow an energy-reduced diet as prescribed by their registered dietician and do physical exercise.
- Satisfactory improvements (expressed in percentages in brackets) in obesity comorbidities such as high blood pressure (48.9%), diabetes (fasting hyperglycaemic decreased in 54.4% of subjects), breathing problems, especially sleep apnoea (17% of subjects had no symptoms anymore), osteoarthritis (no pain in 46.1% of subjects), and raised blood fats (36.5% had reduced triglyceride levels) induced by weight loss, were recorded in a large study involving more than 2500 patients with an average starting BMI of 44.4 kg/m2 after 6 months when the balloon was removed.
Disadvantages of intragastric ballooning
All medical procedures have disadvantages and may cause side-effects, but intragastric ballooning has fewer complications that other more invasive bariatric surgery. The following side-effects have been recorded:
- Pain, nausea and in some cases vomiting, occurs in most patients a few hours after insertion of the balloon. Certain medications can be prescribed to lessen these side-effects. These side-effects usually resolve after a few days, but patients contemplating the procedure should be aware that they may suffer discomfort, pain and vomiting after the procedure. Patients should also be warned to contact their doctor if these symptoms should persist as repeated vomiting can cause dehydration and lead to further complications.
- An increased incidence of gastrointestinal problems such as gastric ulcers and erosions may occur.
- Up to 40% of patients do not achieve the desired weight loss after placement of the intragastric balloon. In most cases this is due to early removal of the balloon because of digestive or psychological intolerance.
- Some patients quickly learn how to circumvent the weight loss effect of their intragastric balloons by eating high-energy, high-fat foods and having additional small meals all day long instead of adhering to their diet prescription
- Patients may regain as much as 41% of the weight they have lost, after the balloon is removed at six months.
(Dumonceau, 2008; Fernandes et al, 2009).
- Internal bleeding or perforation of the digestive tract during placement of the intragastric balloon. Complications can occur during the procedure, no matter how carefully a surgeon proceeds during placement of the balloon.
- Infections may occur after placement of the balloon. However, any clinic or hospital with high standards of hygiene should be able to prevent such infections.
- The most serious complication of intragastric ballooning is the risk of obstructions in the small bowel. This may occur if the balloon leaks or deflates and then passes from the stomach into the small bowel or duodenum where it can cause blockages which in some cases have been fatal.
(Timna et al, 2006; Dumonceau, 2008; Fernandes et al, 2009).
Who is suitable for intragastric ballooning?
The technique of intragastric ballooning has been used successfully as the first step in the treatment of super-obese patients (BMI exceeding 50 kg/m2), to induce some weight loss before they undergo more invasive bariatric surgery. In three studies, researchers found that 90% of the super-obese patients (average BMI = 58-64 50 kg/m2) were able to tolerate placement of an intragastric balloon and lost between 10% and 26% of their excess weight. After gastric ballooning, these super-obese patients who underwent other bariatric surgery had shorter operating times and shorter postoperative stays in hospital. One advantage of intragastric balloon placement for 6 months in super-obese patients prior to other bariatric operations, is that the size of their livers decreases which makes the subsequent bariatric operation easier and less dangerous.
(Timna et al, 2006; Dumonceau, 2008; Fernandes et al, 2009).
Who is not suitable for intragastric ballooning?
The following patients are not suitable and should not contemplate having an intragastric balloon inserted:
- Anyone who has had previous gastric surgery for any reason whatsoever, because the risk of obstructions is increased signficantly
- Patients with a hiatus hernia (5 cm or larger)
- Individuals suffering from coagulation disorders (excessive bleeding)
- Patients with stomach ulcers or erosions or a tendency to gastritis (the balloon may exacerbate the condition and cause excessive bleeding)
- Pregnant women or women who want to fall pregnant, or are breastfeeding
- Persons who abuse alcohol or suffer from drug addiction
- Patients with severe liver disease
- Crohn’s disease (increased risk of bowel obstruction)
- Persons taking nonsteroidal anti-inflammatory drugs (for conditions such as osteoarthritis)
- Psychiatric patients (high incidence of intolerance necessitating premature removal of the balloon)
- Patients with binge eating disorder (up to 30% of obese patients suffer from binge eating disorder which is a predictor of poor results with intragastric ballooning)
Intragastric ballooning in South Africa
This weight loss procedure is available in South Africa and most surgeons should be able to either arrange the procedure for obese patients or refer them to centres where the procedure is performed.
The Bariatric Centres of Excellence at most Netcare Hospitals and the Obesity Unit at the Life Bedford Gardens Hospital advertise intragastric ballooning services and can easily be accessed over the internet.
It is important to keep the following in mind:
- Intragastric ballooning is not intended as a quick fix for individuals who only have a few kilograms to lose.
- It is primarily suited to patients who are super-obese with a BMI exceeding 50 kg/m2
- All patients need to be carefully assessed for physical and psychological complications which could preclude them from having the procedure (e.g. prior gastric surgery, hernia, pregnancy, alcohol and drug abuse, binge eating disorder and other psychiatric conditions)
- Intragastric ballooning is a short-term treatment and any weight lost can easily be regained if the patient does not adhere to his/her lifestyle, diet and exercise changes
- Many patients do not lose significant amounts of weight with this procedure and it cannot be regarded as a replacement for standard bariatric surgery.
- Always consult a registered dietitian to help you with your diet immediately after placement of the intragastric balloon to keep post-placement side-effects to a minimum and then during the 6 month when the balloon is in your stomach to ensure that the diet you use will achieve positive weight loss results and will be able to maintain your weight loss successfully.
- (Dr IV van Heerden, DietDoc, December 2011)
(Dumonceau JM 2008. Evidence-based review of the Bioenterics intragastric balloon for weight loss. Obes Surg, Vol 18(12):1611-7; Fernandes MAP et al, 2009. Intragastric balloon for obesity. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD004931. DOI: 10.1002/14651858.CD004931.pub2 ; Timna N et al, 2006. Intragastric balloon for morbid obesity. Harefuah (Article in Hebrew), Vol 145(11):826-30.)
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