Endoscopic procedures – The Intragastric Balloon
The intragastric balloon is the first of the endoscopic techniques which have the potential to be important means of achieving weight loss without the need for surgery. This is the only endoscopic technique which currently we offer at CBS. But the field of endoscopic techniques for weight loss is a rapidly developing one and further techniques could be available in the not-too-distant future.
The intragastric balloon is a day procedure. You are very lightly anaesthetised during the procedure as it can be unpleasant or uncomfortable. An endoscope (gastroscope) is passed into the stomach via the mouth. Once the tip of the endoscope is in the stomach, a collapsed balloon is passed alongside the endoscope, placed in the stomach and filled with saline to create a volume equivalent to a large orange. The endoscope and filling tube are withdrawn.
The balloon occupies a large amount of space in the stomach simulating a full meal. By this means it reduces your appetite and so making it easy for you to take just two or three small meals per day.
It usually remains in place for 6 months after which it is removed by another endoscopy at which the saline is released and the empty balloon is withdrawn.
The greatest strengths of the intragastric balloon are its relative simplicity and its reversibility. Placing the balloon endoscopically is much less threatening to most people than a surgical procedure. Although an anaesthetist is present and you are sedated, there is no general anaesthetic. There are no incisions and the procedure itself does not lead to any pain. It is very safe. It takes you away from your normal activity for just a day or maybe two days.
The other strength is its effect on your weight. It is not as powerful as surgical treatments but is more effective than almost all non-surgical options. In general, people can expect to lose around 15 kg of weight over the six months that the balloon is in place. Not surprisingly, there is considerable variation due to patient compliance with the eating rules. The balloon does not stop you eating. It simply reduces the appetite so that you can more easily follow the recommended dietary restrictions.
The balloon has several weaknesses. First, it can be very uncomfortable especially early on after its placement. The stomach doesn’t readily accept this big mass in its middle and tries hard to squeeze it out. This can result in nausea and cramping abdominal pains. These are most prominent in the first few days and generally settle by one week. However, during that first week they can be severe. For about 2-3% of people, the symptoms are too severe and the balloon is removed.
Second, the weight loss is modest and inevitably transient. We generally cannot claim it to be substantial or durable. Losing 15 kg would be substantial if your BMI is low (say, in the 27 -35 range) and so there is not so much weight to lose. For instance, if you are just 25 kg over your ideal weight, losing 15 kg is very good. You have lost 60% of your excess weight. But if you are severely obese (BMI > 35) losing 15 kg is useful but is just not enough.
More importantly, the weight loss can be expected to be transient. After we remove the balloon, there is nothing to stop the weight regain. It will not occur immediately but usually by 6 -12 months you are heading back to where you started. You then have to consider another balloon or move onto one of the surgical options.
The final significant weakness of the balloon is the cost. It is not yet accepted by Medicare as a listed procedure and so the basic costs of the procedure are not covered by Medicare or your private health insurer. You have to pay all elements of the costs which can add up to a cost not too different from the cost of a Lap-Band procedure. And the latter does provide substantial and durable weight loss.