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Gastric Balloon – FAQ

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  • How Does the Intragastric Balloon Work?

    No matter which gastric balloon is inserted, they work in the same way. Firstly, they occupy space within the stomach, so that there is less space for food. The stomach varies in size substantially from person to person according to your height, sex and genes. The average stomach is approximately 1.5L in volume, and so the average balloon (filled to 650 mL) reduces the volume of the stomach by less than 50%.

    In fact, the main effect of the balloon is that its slows the passage of food and liquid through the stomach. This makes you feel fuller quicker and longer and substantially reduces the amount you need to eat to feel comfortably full.

    How is The Gastric Balloon Procedure Performed?

    The balloon is introduced into the stomach through the mouth without the need for surgery. The doctor inserts an endoscopic camera (gastroscope) into the stomach. If no abnormalities are observed, the balloon is placed through the mouth and down the oesophagus into the stomach. Once inside the stomach, it is then filled with a sterile saline solution, through a small filling tube attached to the balloon. Once filled, the doctor removes the tube by gently pulling on the external end, leaving the balloon inside the stomach.

    This procedure is performed by a qualified specialist gastroenterologist alongside an anaesthetist and trained nursing staff at several day surgeries and private hospitals throughout within Sydney.

    Placement of the balloon takes approximately 20 minutes, after which patients are monitored by nursing staff in the recovery bay. As this is a “day-only” procedure, patients are generally discharged home within two hours after balloon insertion.

    What Is an Endoscopy?

    Endoscopy is an internal examination performed with a camera and by a specialist doctor, and in this case it refers to the examination of the stomach. All endoscopies must be performed in accredited hospitals and by accredited doctors. Before the endoscopy begins, the patient is deeply sedated by a specialist anaesthetist. The camera (or endoscope) is then inserted through the mouth and into the stomach where an examination is performed to ensure it is safe to proceed with your weight loss procedure.
    In total, the endoscopy can generally be expected to take approximately 20 minutes for balloon procedures (including insertion, adjustment or removal of the balloon). Some procedures, such as an ESG (endoscopic sleeve gastroplasty) may take up to an hour or sometimes even a little longer. Once the procedure is finished, the patient is allowed to wake up and returns home the same day.
    The risks relating to endoscopy are very low: typically, the risk of any complication is much less than 1%, and the risk of major complication is less than 0.1%. Your doctor will discuss endoscopy and any relevant risks specific to your health in your consultation.

    Who Is the Balloon Suitable For?

    The intragastric balloon is designed to assist with weight loss in people who ideally have 10 to 30 kilograms of weight to lose. The minimum BMI is for individuals with a BMI of 27 and greater.
    It is also used for people who are not suitable for other forms of weight loss surgery. The use of the Gastric Balloon may assist in reducing weight prior to surgery, therefore reducing the risks associated with surgical procedures on overweight patients.

    How Long Does the Gastric Balloon Stay in the Stomach?

    The Gastric Balloon can be placed in the stomach for 6-12 months (depending on the type of balloon used). Should your doctor recommend use of the balloon for longer periods, it is necessary that the balloon be replaced with a new one at the six or 12 month interval.

    How Much Weight Can I Lose With The Gastric Balloon?

    It is important for you to understand that the intragastric balloon is a tool to aid weight loss and are most effective when combined with a comprehensive lifestyle programme delivered by your doctor and trained dietitians. The amount of weight loss to be expected is specific to each device; but in general, most devices will achieve 15-20% TBWL (Total Body Weight Loss; ie a 100kg person would lose 15-20 kg on average*). Ultimately, the amount of weight you lose and maintain will depend on how closely you follow the advice of your doctor and our trained dietitians.

    What Will My Weight Loss Journey Be Like?

    After a gastric balloon is inserted, approximately 90% of people have no appetite at all. In the first 10 days you will be restricted to a liquid diet, but most people do not feel hungry! Most women will lose 2-4 kg in the first week; most men will lose 4 – 8kg.

    After 1 – 2 weeks, your appetite may start to return but is typically blunted, and when you do eat, you will get full VERY easily. Our patients tell us they get full on a couple of tablespoons of yoghurt or just two chicken nuggets! (We do not recommend McDonald’s as a part of a weight loss diet)

    During this time, you must eat very slowly and cautiously, as overeating is very easy. If you overeat, your body will give you a signal, whether it be bloating, reflux, hiccups or indigestion. It is very important to pay attention to your body signals: the aim is to learn when you’ve had enough without developing those signals.

    Over the next 6 – 8 weeks, you will gradually be able to increase the amount you eat, although never to what it was previously. Around this time, weight loss will start to slow down and may ultimately plateau.

    With an Orbera® balloon, 90% of the weight loss will occur in the first 3 months, with the second 3 months largely representing a weight maintenance period.

    With the Spatz3® balloon, it is at this plateau phase that an adjustment can be made to increase the volume of the balloon to improve appetite and satiety control and achieve further weight loss.

    What are the Possible Side Effects Associated With the Intragastric Balloon?

    The side effects of the balloon are usually limited to the first 5 days after it is inserted, with the first 3 days being most severe. After this period, the symptoms disappear completely & will only recur (and are typically mild) when one of the “golden rules” are broken.

    Our doctors have worked tirelessly to optimise the treatment of our patients- you will be provided with our highly advanced, unique and comprehensive treatment programme to minimise the side effects you might experience. Most patients of our clinic now typically experience only mild side effects (if any). In addition to the symptoms listed below, patients often feel quite lethargic with a lack of energy in the first few days after insertion and while the body adjusts; although this improves usually within one week. We recommend resting during this period to hasten your recovery.

    There are 4 common groups of symptoms that can be experienced with a balloon:

    • Cramping
      • Cramping is common in the first 3-4 days after a balloon is inserted and can be treated with medications.
      • Overeating, or eating the wrong foods can also bring on cramping.
    • Reflux (including heartburn and some belching)
      • To minimise acid reflux, acid medications are required throughout the duration of the balloon. Over the counter antacid medications can also be used.
      • Overeating, overdrinking, eating rich (creamy/oily) foods or drinking wine will typically bring on acid reflux symptoms.
    • Nausea
      • Typically mild to moderate in the initial days after insertion.
    • Vomiting
      • Typically uncommon or mild with our unique programme and rarely severe. Previously, over 95% of patients would suffer vomiting that was commonly severe.

    How Long Will it Take to Recover After the Procedure?

    You should plan at least three days of inactivity to recover from the procedure. You will be able to resume normal activity sooner or later than this depending on how quickly your body adjusts to the balloon.

    How Will the Balloon Be Removed?

    The intragastric balloon is removed in the same way it was placed, via the oesophagus and mouth using an endoscopic camera. Your doctor introduces a catheter (tube) through the mouth and into the stomach, attaching it to the balloon for deflation. Once the balloon is deflated it can be grasped and removed through the oesophagus and mouth.

    What Are The “Golden Rules”?

    When it comes to eating AND drinking with a balloon, Dr Sartoretto recommends these 3 Golden Rules to minimise the risk of symptoms, optimise the chances of weight loss and improve the odds of keeping the weight off:

    1. Small, single portions
      1. When eating, use a small plate (eg a bread plate or a child’s plate) and serve a portion only the size of the palm of your hand.
      2. Use a small cup- no large tumblers.
      3. Do not set your table with food; instead, serve your portion (and anyone else’s) and pack the leftovers away before you eat.
      4. It is OK to leave some leftover food on your plate.
    2. Go Slow!
      1. Your meal should take you no less than 20 minutes to finish- this ensures you chew your food thoroughly and prevents you feeling unwell after you eat
      2. Sip on your cup of liquid slowly (or consider using a straw)- drinking too quickly will make you feel bloated and uncomfortable.
    3. Wait 30 minutes before you go back for seconds
      1. The brain’s connection with the stomach is delayed- eating too soon after a meal increases the chances of overeating and the chances of developing discomfort.

    These rules prevent you from overeating and allow you to get back in touch with your feeling of fullness. If you break them, you are likely to suffer some reflux or cramping, so sooner or later you’ll change your ways! These altered eating behaviours will remain with you after the balloon is removed and will assist with weight loss maintenance.

    Will the Intragastric Balloon Limit My Activities?

    During the first week of the procedure you should not plan any heavy activities. Once your body has adjusted to the balloon you can continue your normal activities. Starting a regular exercise program is highly recommended and will improve your success.

    Can I Exercise?

    We encourage exercise as part of your weight loss strategy. All activities are encouraged and safe, however, you must wait 3 weeks after an insertion, and 2 weeks after an adjustment to ensure there are no problems with hydration or electrolyte disturbances.

    Does the Gastric Balloon Require Frequent Visits to my Doctor After the Procedure?

    The follow-up program is critical to success of the balloon and in learning new lifestyle skills. You will meet with your lifestyle team at least once a month, during the first six months while the balloon is in place and then bi-monthly once the balloon is removed, for an additional six months. During this time your progress will be evaluated and you will learn valuable principles of health, nutrition and exercise that will provide you a foundation for long-term success.

    Will I be Able to Feel the Balloon in my Stomach?

    There will be discomfort during the first few days after the procedure. From then on, the gastric balloon will give you a feeling of fullness.

    Will the Weight Just Come Back?

    Yes and no – this is a complex question- research has definitively shown that overweight and obesity is a chronic disease- weight almost always comes back, even with surgery! What changes is usually how long it takes the weight to come back.

    Research shows that any weight loss with diet and exercise alone typically returns within 6-12 months. Up to 30% of patients with a surgical sleeve gastrectomy will return to their pre-op weight within 5 years!

    Typically, patients may regain 10-20% of lost weight (eg approximately 2-4 kg following a loss of 20kg) after 12 months. Many of our patients will maintain their weight loss for up to 5 years until bad eating habits return (commonly after stressful periods).

    The key to preventing weight regain after any intervention is active management. On completion of our programme you will be provided with an action plan to monitor your weight with a stepwise approach to preventing its rise. We expect to continue to see you at least on an annual basis after you graduate from our programme to monitor your progress and to help you avoid regaining weight.

    Can I Eat Anything I Want? Are There Any Food Restrictions?

    There are no food restrictions, although you will not feel like eating as much as you used to. In addition, if you eat fatty foods or sweets, you may feel unwell. Excessive overeating while the balloon is in place can prove dangerous.

    Can I Travel?

    Please be aware that gastric balloons are a sub-specialty treatment, and expertise in the care of a balloon is not necessarily widespread. Despite the low risk of complications, it is recommended that overseas travel is not pursued while you have a balloon as expert medical care may not be available and travel insurance will consider the balloon a “pre-existing condition”. The balloon is safely able to tolerate changes in altitude (eg air travel), although transient bloating or cramping may be experienced.

    Will the Balloon Affect My Medications?

    You will be regularly reviewed by our specialists to manage any medications you may be taking and will receive personalised advice in this regard as part of our programme.

    In general however, the gastric balloon may slow down the time it takes for you medication to work- this is because the balloon slows down the time it takes the stomach to empty. Otherwise, gastric balloons do not cause any problems in terms of the effectiveness of medications.

    Anti-inflammatory medications must be stopped and should be avoided with a gastric balloon. This includes ibuprofen (e.g. Nurofen, Brufen, Herron), diclofenac (e.g. Voltaren or Fenac) and meloxicam (e.g. Mobic). These medications increase the risk of developing a stomach ulcer and therefore must be avoided. Cream or gel preparations are OK, as is paracetamol (e.g. Panamax or Panadol).

    Blood thinners would need to be stopped (only with the OK of your prescribing doctor) around the time of an insertion, adjustment or removal. Generally, low dose aspirin (e.g. Cartia) is OK.

    Can I Drink Alcohol?

    Alcohol in moderation is fine.

    Is There Anything I Can’t Eat?

    You will be provided with specific dietary advice from our expert team of dietitians. Around the time of insertion, adjustment or removal, your diet will be restricted, however outside of these periods, you are able to enjoy most foods without concern.

    Some foods may cause symptoms, however. Spicy, rich or tough foods which don’t break down may cause symptoms as outlined above. Red meat and especially steak may cause indigestion. Fish and chicken are generally fine. Fibrous vegetables should be cooked until soft.

    Will I Need Time off Work?

    We generally recommend about 4-5 days off following an insertion to ensure the symptoms have resolved.

    What About Pregnancy and Lactation?

    Pregnancy (or breastfeeding) is no time to be losing weight! Seeking to achieve significant weight loss during these periods can threaten the growth of your baby, so gastric balloons (and other weight loss therapies) should be avoided until after pregnancy and breast feeding has concluded.

    Sometimes, women who suffer with PCOS (Polycystic Ovary Syndrome) may become more fertile as weight is lost, so contraception should be used while a balloon is in place. If you fall pregnant with a balloon in place, the balloon is removed when it is safe to do so, typically in the second trimester.

    Otherwise, there have been no known problems to mother or baby from the presence of a gastric balloon.

    What About Multiple Balloons?

    Multiple balloons can’t be placed concurrently, but they can be placed consecutively. Many of our patients choose to replace the balloon at the end of the first- we have patients that have done this for 4 years running or longer! Using the intragastric balloon in this way helps to maintain weight loss over several years.

    “Maintenance” programmes for gastric balloons are substantially more affordable – contact us for information.

    Are there any other complications?

    Gastric balloons have been in use by our practice and worldwide for over a decade. Complications are very rare and are generally easily managed. These include:

    • Reflux oesophagitis (ulceration of the food pipe due to acid reflux)
      • This can be completely prevented using the acid medication you will be prescribed- it is important to ensure it is taken!
    • Stomach ulcer
      • This depends on the device used, and generally are treatable/curable with medication and uncommonly require removal of the device.
        • Orbera: 0.04% (or 4 in 10,000)
        • Spatz 3: 2 – 5 % (or between 2 – 5 in 100)
    • Bleeding- typically from ulcers and which can be successfully treated with endoscopy in over 99% of cases.
      • Orbera 0.03% (3 in 10,000)
      • Spatz 0.2% (2 in 1,000)
    • Deflation of the balloon: The gastric balloon may rarely deflate. If this occurs, your urine will turn green/blue owing to the dye (methylene blue) in the device. Seeing green urine indicates you require endoscopy within 48 hrs. The risk of balloon deflation is:
      • Orbera: less than 0.1% (or less than 1 in 1000)
      • Spatz 3: less than 1% (or less than 1 in 100)
    • Balloon Migration: if the balloon deflates, it may move out of the stomach and into the small intestine. If this occurs, in most cases the deflated balloon is passed into the toilet with a bowel motion. Rarely, the deflated balloon can cause a blockage or “obstruction” which can require surgery to remove.
      • Orbera Migration: less than 0.05% (less than 1 in 2000)
      • Orbera Obstruction: less than 0.02% (less than 1 in 5000)
      • Spatz 3 Migration: less than 0.1% (less than 1 in 1000)
      • Spatz 3 Obstruction: less than 0.02% (less than 1 in 5000)
    • Gastric Perforation: The balloon may rub against the stomach causing a tear (perforation) or hole.  Patients with a history of prior gastrointestinal or bariatric surgery are contraindicated for any intragastric balloon procedure.
      • Gastric perforation is a serious complication that can occur in up to 1 in 2500 patients.
      • Endoscopy and/or surgery, with removal of the balloon, and repair of the area of bleeding or injury is likely to be required for treatment
    •  Death
      • Less than 0.004%
      • This very rare complication has typically occurred in patients with previous gastric surgery (gastric balloons are contraindicated in anyone with previous stomach surgery), older age (over 65 yrs) and with severe, uncontrolled vomiting over 3 – 5 days.

    What Happens If the Balloon Deflates Spontaneously?

    Your doctor will fill the balloon with a coloured dye inside the balloon called methlyene blue. This will help you clearly identify early deflation or leakage, as it will change the colour of your urine to green or blue. Should this occur you must notify the clinic immediately to have the balloon removed.

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