Endoscopic Intragastric ballooning

Intragastric ballooning is the procedure that involves inserting a deflated silicon balloon into the stomach of a patient. It is a new type of minimally invasive bariatric treatment.

A weight loss balloon is often suggested to patients who are obese or overweight. It is considered an option for those who have not been able to lose weight with lifestyle changes.

It works in combination with lifestyle changes such as changes in diet and regular exercise.

Anatomy of the Stomach

The stomach is a part of the gastrointestinal tract that digests food and sends it to the intestine for excretion. It works by releasing certain enzymes and digestive acids, which break down food and water and help the body absorb the nutrients from them.

The anatomy of the stomach can be understood by its five sections:

1. Cardia: The part of the stomach referred to as the cardia, which consists of the cardiac sphincter. It connects the stomach to the oesophagus and keeps the food from backing up into it.
2. Fundus: The topmost part, just next to cardia is known as the fundus. It stores food only when the stomach is full otherwise it stores the gas that is a byproduct of digestion.
3. Corpus: This part is the body of the stomach in which the food gets mixed with the help of contractions.
4. Antrum: The antrum is located at the lower part of the stomach. It stores the food and further passes it to the small intestine.
5. Pylorus: The bottom-most part of the stomach is known as the pylorus.It connects the stomach to the small intestine and consists of a pyloric sphincter (a ring of tissue) that controls how the food moves from the stomach to the small intestine.

When a patient is obese, he might find it extremely difficult to lose weight with the help of dietary changes and exercise. The reason stands to be the stomach is an elastic organ and expandable as one eats.

The elastic nature of the stomach increases its ability to store food and will make a person want to eat more. A medical procedure such as intragastric ballooning can restrict this flexibility so that you eat lesser.

Not every obese individual can get an intragastric balloon procedure for weight. A person is eligible to undergo this treatment if he/she qualifies for the below requirements:

1. Body Mass Index (BMI): A person with obesity and a body mass index of more than 27 is eligible for a gastric balloon placement. However, your doctor will better diagnose your condition and help you make a choice accordingly.
2. Age: Any adult can undergo this procedure, depending on their BMI.
3. Disqualified for Bariatric Surgery: Some people may not be able to undergo bariatric surgery for weight loss as it may be unsafe for them.
   
   A gastric balloon may help lose some weight to let the patient undergo further bariatric surgery.
4. Class III Obesity: In some cases of high-grade obesity such as Class III (BMI >= 40), bariatric surgery may be suggested by a doctor. However, intragastric ballooning may pose fewer risks.

Note: Although the above-mentioned factors may help find if you are eligible to get an intragastric balloon inserted, it is crucial to discuss it with a doctor.

He/she may be able to advise a suitable treatment plan best suited for your specific condition requirements.

Intragastric ballooning is an endoscopic procedure. This means that an endoscope (a thin tube with a camera at one end) is used to look inside the body while the gastric balloon is transported to the stomach.

The procedure is performed under the influence of a mild sedative. The endoscope goes inside the body through the patient’s mouth, and down through the oesophagus to reach the stomach.

The doctor checks if the endoscope is following the correct path and then it guides the balloon to the stomach. Now, the balloon is filled with a saline liquid or air using a syringe attached to a catheter.

The syringe is detached after the filling-up process. The whole procedure generally takes about 20 to 30 minutes.

A consultation with a doctor can help you find out if an individual is good for gastric ballooning treatment. The doctor is the right person to give proper instructions about the complete procedure.

Before Intragastric Ballooning Procedure

1. A series of lab tests and other examinations may be prescribed.
2. Restrictions on a regular diet and medications if any may be advised by the doctor.
3. The patient may also be asked to start an exercise and diet program to prepare the body for the treatment.

On the Day of Intragastric Ballooning Procedure

1. The patient’s consent may be taken after informing them about the risks and benefits of the procedure.
2. The doctor may prescribe an antacid to prevent acid reflux during the procedure.
3. A liquid diet may be advised in an attempt to empty the stomach for the procedure.
4. The patient may be asked to fast a night prior to the procedure.

A patient’s stomach may need some time to adapt to the regular diet after the insertion of the gastric balloon. 

The Recovery Process in the Hospital

1. Monitoring: The patient may be required to stay under observation for a few hours after the procedure. This helps ensure there is no injury or other complication due to the procedure.
2. Medication: Antibiotics, painkillers or other medication may be given along with intravenous fluids to prevent sudden side effects such as pain, nausea, infection, etc.
3. Dietary Instructions: Liquid diet may be advised for the whole day. Specific dietary instructions will be provided for the upcoming few weeks.

Recovery Process / Expectations After Hospital Discharge

1. Diet: The patient may need to follow a liquid diet and gradually move towards pureed foods and then soft foods for the initial days. A long-term diet may be assigned as per the body’s requirements by a dietician.
2. Medication: A few pain-relieving medicines and antibiotics may be prescribed in case an infection occurs due to the procedure.

First Follow-up Appointment

A monthly follow-up may be advised by the doctor to check if the balloon is at the right place and if there are no signs of complications. It also helps the doctor keep track of the weight loss program.

After a period of about 4 to 6 months, the balloon removal is done by deflating and taking it out through an endoscope. In rare cases, the balloon may deflate on its own it can slip through the digestive tract and may cause discomfort.

Intragastric ballooning through an endoscope is a safe procedure for weight reduction. Some of the benefits of the procedure include:

1. Time-Saving: Insertion of a gastric balloon is a small procedure that does not take a long time. It is a 20 to 30-minute-long procedure. The recovery time is also less compared to other surgical procedures.
2. Minimally Invasive: The gastric balloon procedure does not require incisions as it is performed using an endoscope.
3. Less Hospitalisation Time: The procedure in intragastric ballooning involves less hospitalisation time as it is a small procedure. The patient is kept under observation for a few hours, generally until the sedative wears off.
4. Low Risk of Complications: There are very less chances of developing any complications after the procedure. Symptoms such as nausea, vomiting, etc. may be experienced soon after the completion of the procedure.
5. No Anaesthesia: As there is no incision required in this process, anaesthesia may or may not be administered. It solely depends on the pain tolerance of the patient and the doctor’s advice.

The benefits are many but it is also important to note that weight reduction through intragastric ballooning is a temporary treatment. There is a possibility of regaining the weight you lost during the program.

Intragastric ballooning is a relatively safe procedure. However, alike any other procedure, complications may occur in some patients. These include:

1. Persistent Symptoms: Some people may experience the symptoms such as abdominal pain, acidity, etc. becoming persistent and may not be treated by medications.
   
   The doctor may advise an endoscopy to check if there is a complication making the symptoms persistent.
2. Balloon Deflation: There is a small risk of the balloon getting deflated or ruptured while placed inside the stomach.
   
   In such cases, generally, the balloon moves out of the stomach through the intestines. However, in rare cases, it may cause obstruction which requires an immediate medical procedure for its removal.
3. Hyperinflation of Balloon: In rare cases of intragastric ballooning, the balloon may malfunction and overfill itself after the first inflation. This may require immediate removal of the balloon.
4. Acute Pancreatitis: There have been reported cases of acute pancreatitis in patients with intragastric ballooning. It refers to the condition in which the pancreas experiences inflammation due to pressure applied to it by the balloon.
5. Ulcer Formation: Intragastric balloons are made of silicone and easily contour the shape of the stomach after placement.
   
   However, in very rare cases, an ulcer may form in the oesophagus because of an injury during the balloon placement or removal process. Meanwhile, pressure may also form stomach ulcers in some individuals.

The intragastric balloon treatment is meant to help reduce obesity by reducing one’s appetite. So, a delay in the treatment of obesity may cause risks to health. This may lead to the development of several health conditions such as:

1. Sleep Disorders: Sleep apnoea, is one such common common sleep disorder in obesity. In this condition, the breathing stops and starts while sleeping.
2. Hypertension: Individuals with obesity are at a higher risk of hypertension or high blood pressure. This further increases the risk of heart disease.
3. Heart Diseases: Prolonged and untreated obesity increases the risk of reduced cardiac function and heart disease.
4. Type 2 Diabetes: Due to obesity, excess fat storage can lead to insulin resistance leading to an increased risk of developing type 2 diabetes.
5. Osteoarthritis: The high body weight in obesity can increase the pressure on the joints such as the knees. This increases inflammation, leading to conditions such as osteoarthritis.

When is Consultation with the Doctor Needed?

The patient must contact the doctor immediately if she notices any of the following symptoms:

1. Severe discomfort
2. Severe abdominal and back pain
3. Fever lasting for more than 24 hours

The estimated cost of placing an intragastric balloon is ₹1,50,000 to ₹3,50,000. It can vary depending on multiple factors such as:

1. The consultation fee
2. Diagnostic exams for intragastric ballooning risks and recovery
3. Admission fee
4. The patient's existing medical condition
5. Age of the patient
6. Type of hospital chosen for the procedure
7. The type of room chosen for the recovery period
8. The city where the hospital is located

Obesity can be a leading cause of several health complications such as heart disease, type 2 diabetes, etc. It is crucial to discuss this with a doctor as this condition can decrease the quality of life.

It can be a challenging task for some obese people to lose weight with lifestyle changes such as diet and exercise. A doctor can advise on a personalised treatment plan for each individual.

You can get in touch with the experts at HexaHealth to know the best treatment options available for obesity. We can be your companion from the beginning to the surgical after-care stage.