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Obesity is a complex condition characterized by an accumulation of excess fat in the body. It is considered a major and independent risk factor for several health conditions, such as cardiovascular disease, diabetes, and hypertension. There are several therapies that can help a person in weight loss. These therapies may include medical treatment, endoscopic treatments, and bariatric or weight loss surgery.
What is intragastric balloon surgery?
Intragastric balloon surgery is the most effective, minimally invasive endoscopic therapy for weight loss. It is an intermediate solution between medical treatments and conventional bariatric procedures for obesity. However, like any other weight loss procedure, it also requires a life-long commitment to a healthy lifestyle and regular exercise for permanent success.
Who are the candidates for intragastric balloon surgery?
Intragastric balloons surgery is not an option for every obese individual. An ideal candidate for intragastric balloon surgery must fulfil the following criteria:
- BMI between 30 – 40 Kg/m2
- Willingness to stay committed with lifestyle and behavioral changes throughout life
- An obese individual who is unwilling or not eligible for surgery
Pre-procedure
A complete physical examination is done to check the overall health condition of the patient for undergoing surgery. The patient is advised to undergo certain laboratory tests and examinations to determine any pre-existing condition that may need to be addressed before the surgery. Specific instructions are given regarding exercises and changes in medications. The person is advised to have a fluid diet 48 hours before the procedure. The procedure is usually done in the outpatient unit with or without mild anesthesia.
How the procedure is done?
During the procedure, an anesthetic medicine is sprayed on the throat. After a few seconds, an endoscope (a thin, long, and flexible tube with a tiny camera at one end) is used to insert an uninflated balloon through the mouth into the stomach. After reaching the stomach, the balloon is inflated with sterile saline. Once the balloon is filled, the endoscope is removed leaving the balloon inside the stomach. This procedure usually lasts for about 20 to 30 minutes. Once the procedure is done, the patient’s condition is monitored and discharged. At the time of discharge, the patient will receive detailed instructions about aftercare.
Types of intragastric balloons
Currently, the US FDA has approved only three types of intragastric balloons, they include Orbera intragastric balloon, Obalon intragastric balloon, and TransPyloric Shuttle Delivery device.
- Orbera intragastric balloon: It is the most commonly used balloon. In this procedure, a thin catheter with an elastic silicone balloon is inserted through the mouth into the stomach. Later, an endoscope is also passed to check the balloon placement. Once the balloon is placed in the correct position, it is inflated using saline. Once the balloon is inflated, the catheter and endoscope are removed.
- Obalon intragastric balloon: In this procedure, the balloon is packed in a capsule with a thin catheter attached to it. This balloon is delivered into the patient’s stomach by making the patient swallow the capsule. An ultrasound is used to determine the position of the capsule in the stomach. Once the capsule is placed in the right position, the balloon is inflated with nitrogen gas through the catheter.
- TransPyloric Shuttle Delivery Device: It is a minimally invasive endoscopic procedure, in which a Transpyloric shuttle (TPS) is placed into the patient’s stomach. Once the TPS is placed in the correct position, it is inflated with saline through a TPS controller. The TPS then takes the shape of a smooth large balloon that is connected to a smaller balloon with the help of a flexible silicone tether. The large bulb remains in the stomach and the smaller balloon remains either in the stomach or enter the small intestine.
Post-procedure care
After the procedure, the patient may feel nausea, vomiting and abdominal cramps which may resolve on its own within two weeks. Six hours after the procedure, the patient may have small amounts of clear liquid, which should be continued for a week. During the second week, the person may have a soft or semi-solid diet. Three weeks after the procedure, the patient can get back to the normal diet. However, the patient needs to follow the diet modification as suggested by the doctor.
Usually, intragastrical balloons are left in the stomach for six months after which they need to be removed using an endoscope. Endoscopic removal of the intragastrical balloon may require administration of sedation. Once the patient is sedated, a special endoscopic tube attached with a tiny camera is inserted through the mouth into the stomach. With the help of it, the surgeon deflates the balloon using a special tool. The balloons are then removed along with the endoscope. This procedure usually lasts for about 15 to 30 minutes.
Outlook
With intragastric balloons, a person may lose 7% to 15% of weight during the first six months. However, the amount of weight loss differs from person to person depending upon their lifestyle. An intragastric balloon is a temporary weight loss treatment that helps a person to lose weight within a short duration. For long-term success, the person needs to stay committed to a healthy lifestyle and dietary changes. Like any other weight loss procedures, an intragastric balloon also helps in significant weight loss, and improve or resolve conditions, such as heart disease, type-2 diabetes, and other conditions related to obesity.
References :
- Kim SH, Chun HJ, Choi HS, Kim ES, Keum B, Jeen YT. Current status of intragastric balloon for obesity treatment.
World J Gastroenterol. 2016;22(24):5495-5504.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917609/ - Mayo Clinic. Intragastric balloon.
https://www.mayoclinic.org/tests-procedures/intragastric-balloon/about/pac-20394435 - Abu Dayyeh BK. Intragastric Balloons for Obesity Management. Gastroenterol Hepatol (N Y). 2017;13(12):737-739.\
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5763559/
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