Intra Gastric Balloon (LGB)

Does intra gastric balloon has any role in weigh loss?

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

– It is indicated for temporary weight loss in those who are unfit for bariatric surgery.

– It is a bridging procedure before bariatric surgery to induce weight loss, so as to make these individuals fit for surgery.

– It is also indicated for mild obesity.

– Procedure:

  1. Intra gastric balloon is introduced by performing upper gastrointestinal endoscopy under sedation. 
  2. Obalon balloon can be swallowed. But to check whether you are suitable for ballon procedure, you need to undergo upper gastrointestinal endoscopy before swallowing balloon.

Procedure –

  1. 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
  2. Procedure is done under short general anaesthesia.
  3. 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.
  4. Orbera balloon is an FDA approved balloon which can be kept for 6 months
  5. Orbera 365 balloon can be kept for 1 year.
  6. 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.
  7. Once the duration of 6 months or 1 year is over balloon has to be removed by doing endoscopy.

– Bariatric surgeries are indicated when the body mass index is ≥ 32.5 kg/m2 and life style modifications are enough when BMI is < 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 ≥ 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.

– Once introduced, it occupies part of the stomach and creates sense of fullness. 

– It reduces the amount of food taken each time.

– So IGB acts mainly by mechanical restriction.

– Its induces minimal physiological changes necessary to induce weight loss and diabetes remission. So body fat set point is not altered much.

– It is very inferior compared to bariatric surgeries

– 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 some more will gain weight even in the presence of balloon.

– It is simple, very safe and doesn’t require admission.

– Can be done as a day care procedure.

– Patients will be in a position to leave hospital 12 hrs after the procedure.

– It doesn’t require any cuts on the abdomen. (No scars on the tummy)

– It is a good choice for weight loss in individuals with BMI < 30 kg/m2.

– It is considered as an adjuvant to healthy diet, exercise and behavioral modification in these individuals. In these, since weight burden is not much, fat mass can come down to some extent by healthy diet and exercise. And IGB helps to increase weight loss. After balloon removal, these individuals should stick on to healthy diet and exercise in order to keep fat set point nearer to normal limits.

– After balloon removal, if bariatric surgery is not performed, all the lost weight will be regained in most of the individuals.

– So weight loss after IGB is temporary especially when it is performed in individuals with BMI ≥ 30 kg/m2.

– Those who regain weight after IGB, need bariatric surgery for weight loss.

– 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.

– 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.

Intra Gastric Balloon-Dr.Amar