Intragastric Balloon

Overview

The intragastric balloon system represents a minimally invasive weight loss program designed for individuals grappling with obesity. It melds enduring dietary and lifestyle modifications with the incorporation of a temporary medical implant. This implant, an inflatable balloon, is inserted non-surgically into your stomach (hence the term “intragastric”). Its mechanism involves occupying space, inducing a sense of fullness, and limiting the amount you can consume. The healthcare provider employs an endoscope to introduce the balloon through your throat, eliminating the need for surgical procedures.

Reasons for undergoing the procedure

Obesity brings about physiological changes that increasingly impede weight loss through diet and exercise alone. One notable change is the gradual expansion of the stomach’s volume over time. As the stomach stretches, it accommodates more food, prolonging the time it takes to feel full and encouraging overeating. Hence, medical weight loss procedures commonly involve restricting stomach capacity.

The intragastric balloon stands out as a noteworthy alternative among available procedures. Firstly, it is the only procedure intentionally designed to be temporary. Secondly, its installation does not necessitate surgery, eliminating the need for general anesthesia. This characteristic renders it a suitable option for individuals who either do not meet the criteria for bariatric surgery or prefer a less enduring commitment.

In the United States, the intragastric balloon is presently available to individuals with a BMI of 30 or higher, provided they meet the required health screening criteria for the procedure. Individuals with class III obesity, who qualify for bariatric surgery, may opt for the balloon due to its relatively low risks. Additionally, for those for whom surgery is unsafe due to obesity, the balloon can serve as a transitional measure to lose enough weight, making them eligible for surgery.

Obesity triggers metabolic changes associated with a spectrum of health conditions, ranging from type 2 diabetes and cardiovascular disease to kidney and liver diseases. With a Body Mass Index (BMI) of 30 or higher, the risk of developing these diseases significantly increases. Conversely, a modest weight loss of 5% to 10% can reduce this risk and may even induce remission of these conditions. The intragastric balloon system offers a viable means to achieve this weight loss.

The typical weight reduction achieved with the gastric balloon is approximately 10% of your overall weight or around 30% of your excess weight. This level of weight loss can have a transformative impact on your health within a relatively short timeframe. As with any weight loss regimen, the amount lost may vary based on adherence to the program. Additionally, maintaining the achieved weight loss depends on continued adherence to the program after the removal of the balloon; otherwise, weight regain is possible.

Risks

Commonly, individuals experience mild gastrointestinal symptoms as side effects, and doctors frequently prescribe medications to prevent or address them. Typically, these symptoms endure for about a week, though occasionally they may persist for a longer duration. The symptoms comprise:

• Indigestion
• Acid reflux
• Temporary abdominal pain
• Temporary sore throat
• Nausea
• Constipation

Severe complications are uncommon, although they can manifest. The potential risks encompass:

• Hyperinflation. Spontaneous hyperinflation occurs in slightly more than 2% of individuals. This malfunction involves the balloon overfilling itself at some point after the initial inflation. Persistent gastrointestinal symptoms may result from hyperinflation, necessitating early removal of the balloon.
• Deflation. In the event of balloon rupture or deflation, there is a potential for it to move from the stomach to the intestines, with a risk of approximately 1.5%. Various intragastric balloons are equipped with distinct tracking devices to notify you and your doctor in case of such an occurrence. While most balloons that migrate into the intestines typically pass through without issues, there exists a risk of a balloon getting lodged, leading to intestinal obstruction. Addressing this situation would necessitate an emergency procedure for removal.
• Persistent gastrointestinal symptoms. Persistent symptoms that extend beyond the initial week and are unresponsive to medication occur in fewer than 3% of individuals. For these cases, another endoscopy is necessary to examine the issue, and the balloon may be adjusted or removed accordingly.
• Acute pancreatitis. The speculation is that the pressure exerted by the balloon inside the stomach may compress the pancreas located behind it, leading to inflammation. Acute pancreatitis is typically characterized by pain, and severe cases can be serious. If the balloon is identified as the cause, removal becomes necessary.
• Ulceration. Intragastric balloons are made of soft silicone, designed to be smooth and round, conforming to the contours of your stomach. This design aims to prevent irritation to the stomach lining. However, instances of stomach ulcers have been reported, likely attributed to pressure exerted by the balloon at the bottom of the stomach. Some individuals may also develop ulcers in the esophagus, resulting from injury during balloon placement or removal. The most critical risk associated with an ulcer is that, if left unhealed, it may eventually penetrate through the gastrointestinal lining, creating a hole (perforation) that can lead to a potentially life-threatening infection. The incidence of gastrointestinal perforation risk is 0.1%.

Before the procedure

You will engage in discussions with your doctor to assess your suitability for the intragastric balloon system. If deemed suitable, your doctor will coordinate a team of caregivers to assist you throughout the program. This team may include a nutritionist, gastroenterologist, psychologist/psychiatrist, and possibly other professionals, collaborating to develop a tailored weight loss program for you.

A doctor will outline the risks, benefits, and alternative options for the procedure and seek your informed consent to proceed. It is common for them to initiate acid-blocking medication to mitigate acid reflux both during and after the procedure. Few days before the scheduled procedure, you will be placed on a clear liquid diet to facilitate the emptying of your stomach. The night prior to the procedure, you will be instructed not to consume any food or liquids after midnight.

During the procedure

Most intragastric balloons are inserted by doctors using an endoscope, which is a lengthy, flexible tube equipped with a camera. The endoscope is introduced through your mouth, passing down your esophagus to access your stomach. While the majority of individuals undergo this procedure while awake, a mild sedative is typically administered.

You will receive medication to induce relaxation and numb your throat for the endoscopic procedure. Your gastroenterologist or endoscopic surgeon will commence by inspecting your esophagus and stomach using the endoscope, which displays images on a screen. After confirming that there are no underlying conditions that could pose a risk to the balloon placement, they will carefully guide the balloon into position.

Your endoscopist will utilize a syringe attached to the catheter to fill the balloon and subsequently detach the syringe before withdrawing the catheter. The balloon’s valve automatically seals to prevent any leaks. The filled Orbera balloon occupies approximately one-third of your stomach. Its weight causes it to descend to the bottom, playing a role in its mechanism. Specifically, it hinders the rapid emptying of your stomach through the valve at the bottom (pylorus).

The procedure typically lasts between 20 to 30 minutes. Following the intervention, you will undergo a recovery period in the hospital for a few hours. During this time, you will receive intravenous fluids and medication to manage pain and prevent nausea. Your doctor will assess your tolerance to the balloon before approving your discharge. Additionally, they will provide you with dietary guidelines to follow in the coming weeks. For the remainder of the day, you will adhere to a clear liquid diet.

After the procedure

Your stomach requires an adjustment period before returning to your normal diet with the presence of the balloon. The progression involves initiating a liquid diet and gradually transitioning to pureed foods, followed by a soft diet, and ultimately, adhering to the long-term dietary plan outlined by your nutritionist. Throughout this adjustment phase, you will maintain close communication with your doctor. They will assist you in managing both the physical and psychological side effects that may arise during this period of adaptation.

The Orbera balloon remains in position for a duration of six months. Throughout this period, you will collaborate with your team to implement diet and lifestyle modifications crucial for sustaining long-term weight loss. This involves consuming smaller portions, losing weight, and reacquainting yourself with recognizing fullness cues. As necessary, you will continue to take acid-blocking and anti-nausea medications. The most substantial weight loss typically occurs within the initial three months of this timeframe.

Removal of intragastric balloon

A second endoscopic procedure will be conducted to remove the balloon. To facilitate the removal, you will receive a sedative and a topical anesthetic or lubricant in your throat. Your endoscopist will puncture the balloon, extract its contents through suction, and then withdraw the deflated balloon. Following the removal, your team will persist in collaborating with you for an additional six months to solidify the long-term adjustments to your lifestyle.

Outcome

The intragastric balloon typically results in a substantial weight loss for most individuals, providing relief from numerous physical and psychological challenges associated with obesity. The average weight reduction of 10% surpasses what many can achieve through lifestyle interventions alone. This transformative experience often serves as a powerful motivator for individuals to sustain or further pursue their weight loss journey.

However, the procedure itself is not permanent, and there are no safeguards preventing weight regain after completing the program. Recent studies indicate that only a minority of individuals sustain their weight loss achieved with the intragastric balloon over a five-year period. Certain individuals opt for repeat procedures with the balloon, while others pursue follow-up strategies such as medications or weight loss surgery for a more enduring solution.

In the continual quest for safe and effective obesity treatments, endoscopic procedures such as the intragastric balloon emerge as a significant alternative. These procedures provide significant weight loss with comparatively low risk. Optimal outcomes are achieved through consistent support and follow-up with a doctor. Although the balloon itself is temporary, this ongoing support plays a crucial role in facilitating long-term changes.