Intragastric balloons in detail

The concept of placing a foreign object in the stomach to reduce eating has been around for a long time, but it is only with recent advances in medical technology and design that use of this device has become popular again.

What is the intragastric balloon?

It is a soft, pliable, water-filled silicone balloon about the size of an orange that sits in the stomach, taking up space and creating the feeling of fullness and thereby reducing food intake and aiding weight loss. (Figure 1 & 2).

Figure 1 -
The gastric balloon
 
 Figure 2 -
The gastric balloon in place

The intragastric balloon is inserted by a slim, flexible telescope passed down your throat and into the stomach (a procedure known as an endoscopy). This is done as a day-case procedure with local anaesthetic throat spray and light sedation. It is not an operation. There is no cutting or stitching and it doesn't require a general anaesthetic so it is much simpler and safer than any of the alternative surgical procedures.

What are the down-sides of the intragastric balloon?

  • It MUST be removed after 6 months.  This is because the intragastric balloon may corrode and rupture after prolonged exposure to the stomach acid and digestive juices. So it can only be considered as a short-term measure

  • It doesn't do much on its own.  For successful, healthy weight loss it must be combined with careful dieting and lifestyle changes.  Furthermore, these must be continued after the intragastric balloon is removed so that the weight doesn't just go back on again

  • It is relatively expensive, because the price includes the cost of removing it after 6 months (another endoscopy) as well as ongoing follow-up and support from our multidisciplinary team with regular contact from our specialist nurse and dietitian

  • It tends to lose its effectiveness after 4-6 months.  Another reason to have it removed after that time.

Who is suitable?

The intragastric balloon is only a short-term measure (see below) and so most people who really need a lasting solution to a significant weight problem would probably opt for surgery.  Nevertheless, intragastric balloon insertion may be suitable for these three groups of people:

  • People with BMI greater than 60, who might benefit from some preliminary weight loss over several months with an intragastric balloon to make the subsequent operation (e.g. a gastric bandgastric bypass or sleeve gastrectomy) technically easier, and safer

  • People who are in need of some other operation (such as orthopaedic or cardiac surgery) but who need to lose weight first.   Using the intragastric balloon may get their weight down over several months to make them suitable for their surgery

  • People with BMI 30-35 (below the limit for eligibility for weight loss surgery) who just need a "boost" to get them down initially, after which they can do it on their own with ongoing attention to careful dieting and lifestyle changes

Insertion of the intragastric balloon is NOT recommended for people with large hiatus hernia, chronic stomach ulcers or strictures (narrowing) of the oesophagus (gullet), those who have had previous gastric surgery, people on anti-coagulant medication such as warfarin, people with liver cirrhosis or portal hypertension, or pregnant women.

What's the process?

Once the decision for the intragastric balloon has been agreed upon after discussions with our team, a date will be set and the day-case admission process will be arranged.

24 hours beforehand you begin a liquids only diet.  You come in to hospital on the day of the procedure and the intragastric balloon is inserted by endoscopy. The intragastric balloon is inserted in its collapsed state and then is inflated in the stomach using a sterile saline solution (salt water).  Often a blue dye is added too, so that we will be able to tell if the intragastric balloon leaks or ruptures.  The whole procedure takes about 20 minutes and you will be able to go home a few hours later.

Nausea/vomiting is very common in the first week.  You will be given medication to ease this.  You should just sip fluids in this time.  Eventually you will progress to eating normal food, just in small amounts.  We recommend regular fluids, especially after meals, to help "float" the intragastric balloon up and keep it clean - otherwise food can get trapped around it.  Several days of old food sitting in the stomach can cause bad breath!

We will follow you regularly throughout the 6 months, with the option of another 6 months after the intragastric balloon's removal just to help you with the dietary and lifestyle changes you need to continue to achieve a good result.

As the end of the first 6 month period approaches, we arrange your re-admission for intragastric balloon removal.  This is another day-case endoscopy.  We advise you to restrict yourself to fluids only for 24 hours beforehand, just as for the balloon insertion process.

What happens after the intragastric balloon is removed?

When you go home after the intragastric balloon has been taken out there are no dietary restrictions, so this is a potentially dangerous time for you to regain weight.  We recommend that you stick with the healthy, calorie controlled diet and exercise regime that you practised while the intragastric balloon was in.  We offer a further 6 months of regular follow up and support from our team to help you with this.

Can I have the intragastric balloon re-inserted again?

Yes you can, but you need to wait approximately three months after the first intragastric balloon is removed to allow your stomach to recover.  If you get another one in too soon it doesn't work; perhaps the stomach "gets used to it".

Bear in mind also that patients who return for balloon placement a second (or even third) time do not achieve the same degree of weight loss as when it was inserted the first time around.  Our advice is that if you still need help for sustained weight loss after the balloon has been tried, you should consider one of the surgical options such as the gastric bypasssleeve gastrectomy, gastric band,or duodenal switch.