what are we talking about?
It is a very soft expendable silicone balloon, filled with saline solution that is placed inside the stomach and is kept in that position for a maximum of 6 months.
This device, partially filling the stomach, allows the patient to achieve more quickly a feeling of satiety by stimulating the baroreceptors, and it allows him to feel less hungry. In this way the patient is more easily able to follow the assigned diet.
Such an effect will persist even after removal of the balloon.
Thus it is obtained a restriction of the fillable volume in the stomach, which allows on one hand to reduce the amount of ingested food, on the other hand the slowing of the process of gastric emptying.
The stomach volume is reduced by a quantity comprised between 500 and 700 cc, namely the capability of the intragastric balloon that, inflated, reaches a diameter of approximately 11 cm.
The intragastric balloon must always be associated with a proper long-term diet and with a radical modification of the dietary life style. To achieve the best possible results, it is also essential the assistance of a multidisciplinary team that should be appointed to the support of the patient throughout his treatment.
The maximum time the balloon can stay in its place varies depending on the type of devices, ranging from 3 to 12 months and it must be removed when it is defined by the endoscopist.
What are the conditions for the patient to be able to undergo the procedure of the intragastric balloon?
Basically only two: being obese for a long time and have a body mass index compatible with obesity itself:
- A previous history of obesity for at least 5 years
- A body mass index (BMI) greater than 30.
In particular, the patient suitable for the treatment with the intragastric balloon must have the body mass index of:
- BMI 30-35with comorbidities
- BMI 35-40in case of refusal of surgery
- BMI >50or the decrease of the operating risks (both for the subsequent bariatric interventions, and also for other surgical procedures such as the orthopedic ones).
Patients who have a BMI between 27 and 30 can decide to opt for the positioning of the intragastric balloon for a fee. The two intragastric balloons available for this BMI range are OBALON and ORBERA (Allergan).
The intragastric balloon can be used to:
- In case it is needed to obtain a weight loss in a short time, to support a particular nutritional re-education. We would like to point out that the weight loss and the subsequent weight maintenance will depend on the patient’s willingness to make important changes related to diet and exercise.
- To provide an alternative to other surgical operation when the patience refuses it.
- To reduce surgical risks in patients undergoing bariatric surgery. Numerous studies have shown that a good preoperative weight reduction significantly reduces surgical risk. In particular, it reduces the risks that come with anesthesia, decreases abdominal fat and the size of the left liver, thereby facilitating, from a mere technical point of view, all bariatric surgery.
What are the contraindications to this treatment?
Not everyone can undergo the treatment with the intragastric balloon system: as with any surgery there can be some contraindications that make it not recommended. As regards the insertion of the intragastric balloon contraindications can be Absolute or Relative.
- The patient has an addiction to alcohol or drugs
- The patient is suffering from Peptic Ulcer
- The patient is suffering from an esophagitis greater than the first degree
- The patient is suffering from hiatus hernia greater than 5 cm
- The patient has had a previous bleeding of the gastro-intestinal higher section
- The patient is pregnant
- The patient is suffering from Crohn’s disease
- The patient is suffering from cancer
- The patient is suffering from major psychiatric disorders
- The patient has previously undergone gastrointestinal type of interventions
- The patient takes anticoagulants
Obviously all of these contraindications are approximate. You should always check the possibilities of a candidacy with your doctor.
dr. Andrea Formiga
Abdominal and thoracic surgeon, he is currently the only one in Italy to apply the EndoBarrier Method. He performs, with a wide range of certified operating cases, operations of medium and advanced laparoscopic and thoracoscopic surgery that treat benign and oncological diseases, and deals with the endoscopic/sugical treatment of obesity and diabetes.
dr. Roberto Scarano
Specialist in Abdominal Surgery, he is the Medical Director and owner of the Manara Medical Center in Milan.