Gastric balloon

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Gastric balloon, icon

The gastric balloon (English intragastric balloon ) is a non-operative, endoscopic-interventional method for the treatment of obesity. In some cases, the gastric balloon is also used in very obese patients for preparatory (preoperative) weight loss for a surgical procedure. In contrast to other procedures in the field of bariatric surgery, the gastric balloon is characterized by the fact that no scars are formed. As part of a simple gastroscopy, the gastric balloon is introduced into the stomach via the esophagus under short anesthesia and then filled with a blue-colored saline solution (400–700 ml). The balloon is inserted relatively high up in the stomach and functions as a "placeholder". As a result, only a small part of the stomach is available for food intake, while the greater part of the stomach is excluded from direct food intake. The patient can only eat small meals because the stomach is filled quickly. The receptors, which are located in the stomach wall and measure the expansion of the stomach when food is consumed, inform the brain earlier that enough food has been consumed and the feeling of satiety sets in.

In principle, only patients who are too overweight for a diet alone but who do not yet need a gastric band or another surgical procedure such as gastric bypass surgery to reduce their weight are eligible for treatment with a gastric balloon . If the body mass index ( BMI ) is between 28 and 44 - in special cases also 26 to 46 - the gastric balloon can be used.

The gastric balloon remains in the body for 6–12 months and is then removed with a simple gastroscopy. The balloon is punctured with a needle, the liquid is sucked off and then the empty balloon is grasped with the help of a special gripper and removed via the esophagus and mouth.

Results

The data on the effects of gastric balloons are limited, sustainable weight loss and advantages over treatment through behavior change are controversial. The gastric balloon is accepted as part of a "multi-step therapy" prior to obesity surgery for patients with special risk factors.

Recent studies show that the gastric balloon method promotes long-term, sustainable weight loss if it is practiced as a concept with regular follow-up care by a doctor and nutritionist . Regular exercise is also an important element of therapy. The gastric balloon is seen as an aid to getting into a healthier way of life.

The sometimes propagated method of "misusing" the gastric balloon for quick weight loss shows lasting success only under certain conditions. In the case of unaccompanied weight loss, those affected learn exactly what is wrong in terms of learning psychology. The initially rapid weight loss is accompanied by the loss of lean mass, which results in the development of the yo-yo effect , since the resulting decrease in energy expenditure promotes a subsequent rapid weight gain.

Side effects, complications and contraindications

Most patients suffer from nausea, vomiting and sometimes severe abdominal pain after the procedure, which can last for several days. The risk of gastric ulcers is increased, therefore an acid blocker (e.g. omeprazole, pantoprazole, etc.) should be taken permanently while the balloon is in place. It can also lead to a severe fluid deficit ( dehydration ) and electrolyte shifts. That is why close contact with the gastric balloon patient is very important, especially in the first few days after insertion of the gastric balloon. When the stomach balloon bursts, the urine changes color because the saline solution contains a dye (methylene blue). In this case, the attending physician must be consulted immediately and the gastric balloon removed. Cases of intestinal obstruction (ileus) caused by escaped gastric balloons have been reported in the literature . This risk mainly affects the gas-filled gastric balloons, which empty unnoticed, leave the stomach and get stuck in the intestines.

Deaths have been described as a result of necrosis (death) of the stomach wall or rupture (tearing) of the stomach and duodenum. These deaths only affect patients who have previously had surgery on the esophagus or stomach. For this reason, operations on the esophagus and stomach are absolute contraindications for treatment with the gastric balloon. Further contraindications are a large hiatal or paraesophageal hernia, a current gastric or duodenal ulcer, pregnancy, treatment with blood-thinning agents (e.g. with Marcumar, so-called NOAKS = new oral anticoagulants such as Xarelto, Eliquis, Pradaxa etc.), also eating disorders (anorexia, bulimia, binge eating), severe mental disorders, and alcohol and drug addiction. An article on the removal of a gastric balloon with fatal complications reports on the fatal case of an improperly inserted balloon. In the hands of an experienced gastroenterologist, gastric balloon insertion and removal is an easy and safe method.

literature

  • I. Imaz, C. Martínez-Cervell, EE García-Alvarez, JM Sendra-Gutiérrez, J. González-Enríquez: Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis. In: Obes Surg . 18 (7), Jul 2008, pp. 841-846. Epub 2008 May 6th Review. PMID 18459025
  • M. Fernandes, AN Atallah, BG Soares, S. Humberto, S. Guimarães, D. Matos, L. Monteiro, B. Richter: Intragastric balloon for obesity. In: Cochrane Database Syst Rev. (1), 24 Jan 2007, p. CD004931. Review. PMID 17253531
  • A. Salgado Barreira, T. Queiro Verdes: Efectividad y seguridad del balón intragástrico en pacientes obesos y con sobrepeso. Ministerio de Sanidad y Consumo, Madrid 2007. Avalia-t Nº 2006/03.
  • Marek Buzga et al: Effects of the intragastric balloon MedSil on weight loss, fat tissue, lipid metabolism, and hormones involved in energy balance. In: Obes Surg . 24 (6), Jul 2014, pp. 909-915., 2007 Jan 24, pp. CD004931. Epub 2014 February 1st Review. PMID 24488758
  • SC Dai, M. Paley, V. Chandrasekhara: Intragastric balloons: an introduction and removal technique for the endoscopist. In: Gastrointest Endosc. 82, 2015, p. 1122. (giejournal.org)
  • Seung Han Kim et al .: Current status of intragastric balloon for obesity treatment. In: World J Gastroenterol. 22 (24), Jun 28, 2016, pp. 5495-5504. PMC 4917609 (free full text).
  • A. Genco et al: Multi-center European experience with intragastric balloon in overweight populations: 13 years of experience. In: Obes Surg. 23, 2013, pp. 515-521. PMID 23224509 .
  • A. Genco et al .: Adjustable intragastric balloon vs non-adjustable intragastric balloon: case-control study on complications, tolerance, and efficacy. In: Obes Surg. 23, 2013, pp. 953-958. PMID 23526067 .

Individual evidence

  1. ↑ Interview with internist Dr. Birgit Gergelyfy . As of October 7, 2011.
  2. ↑ M. Bužga, M. Evžen, K. Pavel, K. Tomáš, Z. Vladislava, Z. Pavel, Z. Svagera: Effects of the intragastric balloon MedSil on weight loss, fat tissue, lipid metabolism, and hormones involved in energy balance. In: Obesity surgery. Volume 24, Number 6, June 2014, pp. 909-915. doi: 10.1007 / s11695-014-1191-4 . PMID 24488758 . PMC 4022986 (free full text).

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