What You Need to Know About Gastric Balloon Procedures
August 5, 2016Life-Changing Weight Loss, Without Surgery - The Gastric Balloon
If you have tried to lose weight in the past with little success, but are not ready or do not qualify for a more complicated gastric procedure, the Gastric Balloon may be a good solution. Gastric Balloons have been used as a temporary weight loss device for some time in many parts of the world. Our medical center, Eviva®, was part of the clinical trial for Orbera™ balloons that helped with the FDA approval. In 2015, the FDA approved the use of Gastric Balloons in the United States.
This incision-less procedure is a simple concept. A deflated silicone balloon is inserted using an endoscope under IV sedation or monitored anesthesia care. This is a flexible scope with a camera on the end that allows the surgeon to navigate through the throat to the stomach. Once it is safely in the stomach, the balloon is filled with saline (salt water). A filled balloon reduces the amount of food the patient can eat as well as providing a feeling of fullness. Unlike bariatric surgery, the balloon does not alter the anatomy of the stomach and is completely reversible. However, Gastric Balloons are a temporary treatment and must be removed after six months. At the end of six months, the physician will again use the endoscope to deflate and remove the balloon.
The balloon is a great solution for someone who is looking to jumpstart their weight loss when other options have not worked well.
Types of Balloons
Currently, there are two balloons approved by the FDA. The Orbera™ balloon has been proven to be a safe and effective weight loss solution with over 220,000 placements worldwide. It is a single balloon that is filled with saline until it is about the size of a grapefruit.
Reshape™ is a dual balloon system in which two connected balloons are filled with saline. The dual balloon is designed to conform to the curvature of the stomach for comfort and also includes an anti-migration feature, so if one balloon deflates, the second balloon prevents the device from passing into the intestines for increased safety.
Weight loss results for the two balloons are very similar. Patients will need to talk to their physician to determine which will be the best fit for them.
Outcomes From Gastric Balloons
Having a balloon procedure will not guarantee weight loss. Similar to all other bariatric procedures, it is a tool to help with weight loss.
In order to be successful, it will be crucial to find a program with appropriate support. A comprehensive center will be equipped with experienced and licensed physicians, dietitians, psychotherapists, and fitness specialists to guide patients on their weight loss journey. Having a consistent and defined program will be vital so that lifestyle changes can be made while you are in the therapeutic stage of treatment. Most balloon programs are 12 months. The first six months are the therapeutic months with the balloon implanted. The balloon is removed after month six and the patient will continue to be seen by the physician, dietitian, psychotherapist, and fitness specialist in order to reinforce the lifestyle changes. These lifestyle changes are what will allow the weight you lose to be maintained once the balloon is removed.
Typical weight loss with a balloon is around 25% of excess body weight or 12% of total body weight. Weight loss is directly affected by compliance to diet and exercise protocols.
Weight regain will likely occur if lifestyle changes are not continued after the balloon is removed. We are seeing while the balloon is in the patient, the weight loss is higher on average, especially if they incorporate the other lifestyle changes. Once it is removed, some patients regain weight, which is why it is recommended that ongoing follow-up is necessary to help with the lifestyle changes. Early reimplantation may be an option for those who feel they need the balloon in place. We would wait at least a month before considering that option. Long-term use is not recommended and those patients should consider bariatric surgery.
What You Can Eat With the Balloon
You will initially be on a liquid diet following placement of the balloon to help with nausea as your body gets used to the balloon. Your diet will transition slowly to a pureed diet and then advance to a mechanical soft diet. Once adjusted to the balloon, most patients will be able to eat normally. An appropriate diet will focus on smaller portions and variety. It is important to follow the diet recommendations in order to be successful with your weight loss.
Insurance, Cost and Patient Info
Currently, insurance will not cover the balloon. However, many of the appointments with the providers in the 12-month program may be covered which will reduce the program cost.
The cost will vary depending on the program and type of balloon you decide to use. A 12-month program that is all inclusive can average $7,000-10,000 for a complete self-pay price. This will cover both required endoscopies, multiple appointments with the physician, dietitian, psychotherapist, and fitness specialist through the 12-month period, as well as the cost of the balloon itself.
The balloon procedures are recommended for ages 18 years or older and with a body mass index (BMI) of 30-40. Off-label use of the devices with a BMI of less than 30 or greater than 40 will depend on the center. However, the manufacturer cannot endorse its use in these patients. It will depend on the center and their placement criteria.
Risks and Contraindications
While the balloon is a simple procedure there are still some risks.
- Severe nausea the first few days is very common. You will be given anti-nausea medication to help prevent this. Despite treatment, some patients are unable to tolerate the balloon due to nausea.
- Early removal has occurred in some patients due to intolerance. Some patients need IV fluids the first week or medications to help them through their nausea.
- Dehydration is a risk due to difficulty consuming adequate liquids. This usually resolves after the stomach adapts to the balloon.
- Balloon deflation can be a dangerous complication in which the silicone balloon is compromised, deflates, and potentially migrates into the small bowel causing obstruction. Deflated balloons must be removed endoscopically. Some physicians will put a methylene blue dye in the balloon. This will turn the patient’s urine a blue-green color in the event that the balloon ruptures or has a leak. The Reshape’s dual balloon system helps prevent it from migrating through the stomach in the case of one of them rupturing. The incidence of this occurring is low.
- Ulcers can develop from the balloon irritating the lining of the stomach. It is important to avoid the use of NSAID’s such as ibuprofen and naproxen while the balloon is in place. Patients are typically given omeprazole or other proton pump inhibitors to reduce stomach acid while the balloon is in the stomach.
- Gastric perforation is rare but has been seen in patients who have had previous stomach surgery, such as a gastric band.
There are some contraindications to having a balloon placed.
- Prior history of bariatric or stomach surgery, especially RNY Gastric Bypass, Sleeve Gastrectomy, gastric surgery, or Nissen fundoplication
- Anomalies in the GI tract such as large Hiatal hernias (greater than 5cm), severe inflammation in the esophagus or presence of stomach ulcers
- Currently pregnant or breastfeeding
- History or current use of blood-thinning medications, such as Coumadin or Xarelto
- Severe liver damage such as cirrhosis
Gastric Balloons provide a new, safe, less invasive, weight loss option for patients that have not had sustained weight loss with diet and exercise alone. Endoscopic treatments are likely to grow as people look for better long-term solutions for weight loss.
 | ABOUT THE AUTHOR One of the nation’s foremost experts in bariatrics, Peter Billing, MD, FACS, serves men and women in both Lynnwood and Kirkland, Washington, with a range of weight loss solutions. As founder and owner of Transform Weight Loss, he and his dedicated team offer compassionate and customized care to anyone seeking freedom from obesity. An industry veteran with more than 20 years of experience, Dr. Billing is heralded as an innovator and early adopter of some of the most groundbreaking bariatric and metabolic procedures. |
 | ABOUT THE AUTHOR Josiah Billing is a MBSAQIP clinical reviewer and researcher at Eviva. He graduated from Western Washington University in 2013 with a degree in Cellular and Molecular biology. He is responsible for collecting and submitting accurate, complete and timely data to the MBSAQIP Data Registry Platform. Since graduating, he has been published in the journal SOARD, helped write a textbook chapter on the sleeve gastrectomy, and has also presented scientific posters at the annual Obesity Week conference. Currently, he is researching body composition post sleeve gastrectomy. |
 | ABOUT THE AUTHOR Debie McSperitt RDN, CD is an experienced registered dietitian with an extensive background in weight loss surgery nutrition, a degree from Bastyr University, and a Level 2 Certificate of Training in Adult Weight Management. Debie practices at Eviva Medical Center and is able to work with patients to create their own unique approach to weight management. She is also experienced in both western and holistic medicine, including food allergies, digestive disorders, celiac disease, cardiovascular disease, vegetarian/vegan nutrition. |
