Are Intra Gastric Balloons effective for weight loss?- Can they replace Bariatric Surgery?- Dr. Amar

Does intra gastric balloon has any role in weight loss?

Intra Gastric Balloon insertion is an endoscopic non surgical procedure to treat obesity.

Eligibility –
Bariatric surgeries are indicated when the body mass index is greater than = 32.5 kg/m2 and life style modifications are enough when BMI is less than 27.5 kg/m2. When BMI is between 27.5 and 32.5 kg/m2, and patients are not able to lose weight by lifestyle modifications, then intra gastric balloon insertion can be considered. It can be considered even in those whose BMI is greater than = 32.5 kg/m2 who need bariatric surgery but are afraid to undergo the surgery. Generally it is considered in patients with 05 to 10 kg overweight.

Procedure –
For any balloon procedure it is necessary to do upper gastrointestinal endoscopy, to make sure that there are no contraindications for balloon insertion such as large hiatal hernia, reflux esophagitis, gastric ulcers and gastritis

Procedure is done under short general anaesthesia. After performing the upper GI endoscopy, silicon balloon along with tube and guide wire is introduced into the stomach. After making sure that the balloon crossed the gastro-esophageal junction, guide wire is removed and balloon is filled with 500 to 700 ml saline mixed with methylene blue through the tube connected to the balloon. The actual volume upto which balloon is filled is decided under vision. Once balloon is filled to the desired volume, tubing is pulled out and a valve seals the balloon and tubing junction.
Orbera balloon is an FDA approved balloon which can be kept for 6 months
Orbera 365 balloon can be kept for 1 year.

In Spatz adjustable balloon, there is an elastic tube attached to the balloon. It can be used to fill the balloon more than once. Initially balloon is filled to 300 to 400 ml. Once patient gets adjusted to the presence of balloon, endoscopy can be done to refill the balloon to increase to the desired volume of 600 to 800 ml. Volume can be further adjusted in future depending on whether the weight loss is as per the expectations or if there is balloon intolerance.

Once the duration of 6 months or 1 year is over balloon has to be removed by doing endoscopy

How does it work –
Weight loss is because of food restriction. It doesn’t change the hormones controlling body fat. So it is very inferior compared to bariatric surgeries

What are the results –
IGB combined with lifestyle modifications can result in 5 to 10% of the total body weight loss. To improve the outcomes Oral Semaglutide can be added. On average patients lose 05 to 10 kg of the weight. There are people who lost more than 30 kg weight also. But that will be 1 or 2 out of 100. Based on those 1 or 2, we can’t claim that everyone loses weight similarly. And some people may not lose weight at all after balloon insertion. And even some more will gain weight even in the presence of balloon.

Advantages –
No scars on the tummy.
Can be done as a day care procedure.
Patients will be in a position to leave hospital 12 hrs after the procedure.

Disadvantages –
It is very safe procedure.
But in the initial 1 week to 10 days, patients can have severe nausea, vomitings and colicy abdominal pain. Generally these symptoms will subside with medications and stomach gets adjusted for the presence of balloon. If the symptoms are intolerable, some may require balloon removal.
Spontaneous balloon leak or deflation can occur rarely. If the patient notices, urine turning into light blue color, then U have to consult your doctor to consider balloon removal. If balloon deflation or leak is unnoticed, it can deflate completely and pass through intestines. If it happens, it can block the intestine leading to intestinal obstruction requiring laparoscopic removal by opening the intestine.

Perforation of stomach is a rare complication of the balloon which requires laparoscopic management.

There will be some fullness as long as ballon is inside.

Post procedure –
Just like after any bariatric surgery, follow up at regular intervals is needed. Initial 2 weeks will be liquid diet, followed by healthy soft diet and then healthy normal diet.

In general balloons are very less effective, compared to bariatric surgeries. Balloons are generally for temporary weight loss. Endoscopic Sleeve Gastroplasty is a better choice compared to Intra Gastric Balloon if anyone is afraid of surgery.

If anyone need 5 to 10 weight loss and want to check if IGB is the right choice, please do not hesitate to contact me.

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Dr. AMAR VENNAPUSA
Chief Consultant Bariatric & Metabolic Surgeon
Dr. Amar Bariatric & Metabolic Center,
Hyderabad, India
www.drvamar.com
+91 9676675646
[email protected]

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