BODY MASS INDEX
Studies have shown that intragastric balloon is a safe and effective procedure for temporary weight reduction with low mortality and morbidity. First, in 1985, gastric balloon filled with air was applied. However it was abandoned in the following years due to complications and limited weight loss. With further studies, gastric balloons filled with liquid were put into practice. Orbera, Reshape, Spatz, Elipse and Medsil are the major balloon brands.
Gastric balloon is an endoscopic procedure applied in super obese patients who can not lose over weight with diet and exercise and those who have a BMI between 30-35, have a BMI over 35 but can not undergo surgery and for those with a BMI over 50.
The purpose of the gastric balloon is to reduce the portion of the consumed portion by covering the capacity in the stomach and to provide a feeling of fullness and satiety in the stomach. So, portion control is provided more easily. Studies have shown that the gastric balloon has positive effects on blood sugar level and blood lipid level. It should not be forgotten that the gastric balloon is a method that helps to lose weight. However, maintaining the ideal weight is possible with changing the lifestyle. For this reason, gastric balloon should be supported with diet and exercise program after implementation. An average of 15-25 kilos or 10-15% of the weight can be lost with a gastric balloon. The amount of weight changes from person to person according to age, metabolic rate and frequency of exercise.
The gastric balloon is attached with short-acting anesthetic drugs under general anesthesia in the endoscopy unit or in an operating room conditions. Processing time takes 5-10 minutes. Endoscopy is definitely performed before the gastric balloon is attached. It is checked whether there is any obstacle for the gastric balloon. Then the balloon is placed in the stomach with the help of the catheter which is connected to the tip. Depending on the size of the stomach, the balloon is inflated with methylene blue saline between 500-700 cc. Then the balloon is detached from the catheter and the operation ends.
One hour after the operation, the patient starts taking liquid food and can be discharged after 3-4 hours. The first 3 days after the operation, the patient is fed with liquid foods without grains. The next 4 days she/he is fed with cooked vegetable dishes. After a week, she/he starts to be fed with solid food. However, foods with less volume but high caloried nutritions such as pastries, processed carbohydrates, chocolate, desserts with sherbet and energy drinks should not be consumed.
The balloon remains in the stomach for 6-12 months depending on the type of balloon inserted, and it is removed from the stomach by evacuating it with the help of endoscopy and under general anesthesia. There is no puncture in balloons which are used today. However, in a possible puncture, the methylene blue in the liquid passes into the urine and the color of the urine turns blue. In this case it is understood that the balloon is pierced and it should be removed by contacting the doctor. After the gastric balloon is attached, there may be complaints of nausea, vomiting and stomachache for 3-7 days. However, after 7 days, no problem is encountered as long as the portion size and eating speed are paid attention.
In which situations intragastric balloon is not inserted;
Those with a story of stomach surgery in their past
Those with a tumor or cancer history on endoscopy
Stage 3-4 esophagitis (Esophagitis)
Those with a stomach hernia larger than 5 cm
Those with a psychiatric illness
Drug and alcohol addicts
Those with stomach and duodenal ulcers
Spatz adjustable gastric balloon
This can be adjusted by increasing or decreasing the volume of the balloon with the help of the long apparatus which is in the gastric balloon. The balloon can be inflated between 400-700 cc endoscopically.
Capacity increase is done in order to expand the volume of the balloon and increase weight loss in cases where the effectiveness of the balloon decreases. Capacity reduction is the reduction of the fluid inside the balloon to prevent the balloon from being removed in cases where the patient can not tolerate the balloon. With adjustments, it provides an opportunity for the balloon to remain in the stomach for longer and it provides for longer-term behavioral change.
The spatz adjustable gastric balloon remains in the stomach for 12 months and is then removed from the stomach again by endoscopy.
The ReShape duo is placed endoscopically into the stomach. It is a double balloon system designed to stay in the stomach for 6 months. Purpose in the double balloon system is even if one balloon is punctured, the other balloon will remain intact, preventing the balloon from passing to the small intestine and causing intestinal obstruction.
The Elipse is a new intragastric balloon introduced recently. A swallowable capsule is inserted into the stomach through a catheter. After confirming that the capsule is in the stomach with radiological graphy, it is inflated with 550 cc of liquid and it is turned into a balloon. Therefore, it does not require endoscopy or anesthesia during insertion or removal. After four months, a self-releasing tap opens and the thin wall of the balloon gradually deflates and is thrown from the gastrointestinal canal.
There are cases reported in the literature that the balloon passes into the intestine and causes intestinal obstruction before melting completely.
The Medsil balloon is placed in the stomach by endoscopic process. It is inflated with 500-700 cc methylene blue saline depending on the size of the stomach. The balloon remains in the stomach for 6 months. Then, the liquid inside is removed by aspirating with the endoscopic process.
The Orbera balloon is placed in the stomach with an endoscopic process. Depending on the size of the stomach, it is inflated with 400-700 cc methylene blue saline. The balloon can remain in the stomach for 6-12 months. Then, the liquid inside is removed by aspirating with the endoscopic procedure.