SWALLOWABLE GASTRIC BALLOON (SGB)
Do swallowable intra gastric balloons have any extra advantage over regular balloons?
– 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.
– Swallowable balloons are recent addition and the companies claim that there is
no need for endoscopy
no need for anaesthesia
no need for surgery
How far these claims are valid?
And what is being hidden?
- Intra gastric balloon is introduced by performing upper gastrointestinal endoscopy under sedation.
- But 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.
- 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 gastric ulcers, gastritis, large hiatal hernia or reflux esophagitis. Saying that no endoscopy is required is actually misleading the patients.
- In swallowable balloons, patient swallows the ballon which is in the form of a pill. Its position is confirmed by the fluoroscopy and balloon is filled up to 400 to 550 ml.
- Anaesthesia is not required for this balloon insertion.
- After 16 weeks, balloon spontaneously degrades and passes out through the anal canal.
– 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 swalloable 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 Swallowable gastric balloon 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
– Swallowable gastric balloon 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 immediately 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 swallowable gastric balloon helps to increase weight loss. After balloon spontaneously degrades or passes away, these individuals should stick on to healthy diet and exercise in order to keep fat set point nearer to normal limits.
– Weight loss is because of food restriction. It doesn’t induce physiological changes that are needed to induce weight loss. So it is very inferior compared to bariatric surgeries. So any balloon procedure can’t replace bariatric surgeries. Those who require bariatric surgeries don’t actually benefit from balloons.
– After balloon degrades or passes off, if bariatric surgery is not performed, all the lost weight will be regained in most of the individuals.
– So weight loss after Swallowable gastric balloon is temporary especially when it is performed in individuals with BMI ≥ 30 kg/m2.
– Those who regain weight after swallowable gastric balloon, 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.
– No anaesthesia is required but what about radiation? Fluoroscopy has a radiation equal to 75 to 300 Chest X Rays. We are exposing the patient to unnecessary radiation. Anaesthesia is better than radiation.
– 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.
– In general balloons are very less effective, compared to bariatric surgeries.
– And swallowable balloons are even less effective because the volume is relatively less.
– Balloons are generally for temporary weight loss.
– Even if it is swallowable balloon, it is not advisable to do the procedure without prior upper gastrointestinal endoscopy to rule out any contraindications.
– And patient is exposed to unnecessary radiation.
– Its volume is 400 to 550 ml. Regular balloons up to 800 ml.
– It stays only for 4 months. Regular balloons stay for 6 months to 1 year.
– There is radiation equal to 75 to 3000 Chest X Rays with Fluoroscopy (Needed for this balloon).
– No radiation with regular balloons.
– At the end any balloon is ineffective as it don’t change hormones
– Endoscopic Sleeve Gastroplasty is a better choice compared to Intra Gastric Balloon if anyone is afraid of surgery.