Intragastric
balloon procedure
A gastric balloon aims to reduce
feelings of hunger and help patients feel fuller for longer after eating only small
meals. Also known as an intragastric balloon, this type of weight loss
treatment can help people lose weight without invasive surgery. One type of
gastric balloon is known as Orbera™.
During the procedure a soft
balloon is inserted into the patient's stomach through their mouth, using an
endoscope (a thin, flexible telescope). The balloon is then filled with saline
solution to partially fill their stomach, leaving less room for large amounts of
food or drink. A gastric balloon is designed to be a temporary weight loss
solution, and will usually be removed after about 6 months. It is sometimes used to
help people lose enough weight to undergo gastric
banding or gastric bypass surgery.
About the gastric balloon
procedure
Gastric balloons are inserted
under sedation in a procedure that takes 20 to 30 minutes. It is a relatively
minor procedure, but it may take the patient's stomach a little while to get used to the
balloon. Patients will usually be able to go home on the same day, or the day after the
balloon has been inserted.
Schematic diagram showing an intragastric balloon inside the stomach.
In a small number of cases,
patients may not be able to tolerate the balloon for the full 6 month period
and when this happens, it will need to be removed early. There is a
possibility this may happen in the first few days after the balloon is placed,
if side effects (including nausea and vomiting) do not resolve or are worse
than anticipated.
Intra-gastric
balloon FAQs
What is an intra-gastric balloon?
An intra-gastric balloon is a soft silicone balloon which is placed into the stomach and filled with a sterile saline solution. The balloon partially
fills the stomach which leads to a feeling of
fullness. The intra-gastric balloon helps patients to
control their portion sizes and can lead to
weight loss when combined with an appropriate diet
and behavioural modifications. It is
recommended for patients who need to lose weight
before an operation, to reduce their
surgical risk. It can also be used as a stand alone,
non-surgical treatment option for weight
management.
What happens during intra-gastric balloon
insertion?
The balloon is inserted into the stomach through
the mouth and gullet (oesophagus). Patients
are sedated for this procedure. Once in the stomach, the balloon is filled with
liquid so that it partially fills the stomach. The balloon can be left in place for up to six months,
after which it must be removed.
What will happen on the day of the procedure?
When patients arrive at the hospital, they will usually book in
at reception and take a seat in the waiting room. They will then be seen by the pre-assessment
nurse who will take their blood pressure, temperature, pulse and oxygen levels. They will also
be asked questions about their medical history to ensure that they are fit for the
procedure and have stopped any medications as advised by the consultant surgeon caring for them.
The procedure will be explained to them again and
the consultant surgeon will ask them to sign a consent form if they have not already done this. Once they have been assessed, they will have a cannula
(a tube which delivers or removes fluids from the body) inserted into one of their veins and they will change into a hospital gown. They will then be taken into the procedure room where they will be given a sedative (usually midazolam and fentanyl) to help relax, while the
procedure takes place.
After the procedure, patients will be sent to the
recovery area where the nursing staff will monitor their blood pressure, temperature, pulse and oxygen
levels. Patients must not have anything to eat or drink on the
day of the insertion, so the doctor will give them fluids via the cannula to keep them hydrated.
Following the recovery period, patients will be
transferred to a ward, where they will remain
overnight.
Why should I have an intra-gastric balloon
insertion?
It is recommended for patients who need to lose
weight before an operation to reduce their
surgical risk, or it can be used as a stand alone,
non-surgical treatment option for weight
management.
Intra-gastric balloon insertion is also recommended
for patients who:
- have significant health risks related to their obesity, such as a BMI (Body Mass Index) of more than 40kgs/m2, or a BMI of more than 35kgs/m2 as well as diabetes, fatty liver disease, high blood pressure, polycystic ovary syndrome or arthritis.
- have failed to achieve and maintain weight loss with a supervised weight control programme and have previously been prescribed orlisat sibutramine or rimonabant as weight reducing therapies.
- are not candidates for obesity surgery and have been seen by a healthcare professional such as a nurse, doctor and/or dietitian before being seen by the consultant.
The balloon creates a feeling of fullness and
allows patients to change their eating pattern, reduce the volume of food eaten and help them feel fuller
quicker. The intra-gastric balloon works best when patients
maintain a low calorie diet and close contact with the doctors and nurses caring for them
during the time the balloon is in place.
What are the risks?
While most people do not experience any
complications at all, patients must be aware of the potential risks:
- Bleeding or perforation can occur as a result of injury during the balloon insertion or removal. This may require surgical intervention.
- Gastric discomfort, nausea and vomiting are common for the first few days following balloon placement but rarely continue in the longer term.
- Feelings of heaviness in the abdomen, abdominal and/or back pain, gastro-oesophageal reflux (where stomach acid leaks out of the stomach) or indigestion have also been reported.
- Should the balloon deflate spontaneously, intestinal obstruction by the balloon may cause further problems. If a partially deflated balloon passes into the small bowel, the balloon will need to be removed. A blue dye in the balloon acts as an early warning system against this unlikely occurrence.
A full list of risks will be explained to the patient by
the doctor undertaking the procedure before the patient is asked to consent by signing the consent form. If the patients has any bleeding disorders or is taking
warfarin or high dose aspirin, then he or she must inform the doctor.
Are there any alternatives to intra-gastric band
insertion?
This procedure is usually offered if patients have
failed to achieve and maintain weight loss
with a supervised weight control programme, but
patients must have tried diet and exercise
therapy before this.
How can I prepare for intra-gastric balloon
insertion?
Seven days before the procedure, patients are usually been seen by
a dietitian to organise and discuss their post-procedure diet. They must not eat anything for 12 hours before the
procedure and they must not drink for 6 hours before the procedure. Tablets may be taken
with sips of water only on the morning of the operation.
Giving my consent (permission)
The staff caring for the patient may need to ask for their permission to perform a particular treatment or investigation. Patients will be asked to sign a consent
form which states that the patient has agreed to the treatment and that they understand the benefits,
risks and alternatives. If there is anything patients do not understand or if they need more time to think
about it, then they should tell the staff caring for them.
Patients must remember, it is ultimately their decision. They can change their mind at any time, even if they have signed the consent form. However, they must let staff know immediately if they changed their mind. Their wishes will be respected at all times.
Will I feel any pain?
Patients may feel some gastric discomfort, nausea or
vomiting for a few days following the procedure but this must not continue in the long term. Patients need to contact their family doctor (GP) if this discomfort persists.
Patients must not undertake any physical activity for at
least 24 hours following their procedure and they must stick to gentle activity for at least 7 days after the balloon is fitted. Patient will be prescribed:
- acid reducing drugs to combat the gastro-oesophageal reflux and indigestion whilst the balloon is in place
- anti-sickness tablets for a week following insertion
- painkillers such as hyoscine butylbromide (Buscopan®) to reduce spasms in the gut during the week following the insertion.
These medicines will be prescribed by your doctor.
What do I need to do after I go home?
Day one
The medical team will normally see the patients on the ward on the
morning after their insertion and will encourage them to take oral fluids. Patients will need to
start with sips of water and then gradually increase the amount which they are drinking until they are able to manage good amounts of fluids. Patients will then be discharged home later that day. They must not take part in any physical activity.
Day one to three
Patients can start on a liquid diet on days one to
three, including thin soups, fruit juices and milk. No solid foods must be eaten. They should not
exceed 1000Kcal/day at this time. Patients will normally have met with the dietitian to ensure that their calorie intake is adequate and that they are receiving all the nutrients they need.
They must drink plenty of fluids – up to 2 litres
per day, but they should do so slowly. They
must avoid coffee, fizzy drinks, fatty foods,
chocolate and ice cream.
Day four to seven
Patients can now start eating a semi-solid diet, that can include foods like porridge, thicker soups, and fruit purees. Gentle physical activity may be
undertaken.
Day seven
Patients will usually be seen by a dietitian.
Day eight and onwards
Patients must be able to start a solid diet, although their calorie intake must remain at 1000–
1200kcal per day maximum. Patients must aim to maintain a low-fat diet at all
times. They must not drink whilst eating, although they can have a few sips if necessary. They should always eat food first and then drink. They must remain on this diet for the duration of
the balloon therapy.
Their dietitian will usually discuss this with them further.
Source: NHS Choices.
Source: NHS Choices.