A gastric balloon is an effective endoscopic method for weight loss. It is indicated for obese patients or individuals with overweight who have already undergone multiple interventions, with minimal success, or who have not been able to undergo bariatric surgery yet. Gastric balloons are significant, as now more than one in ten adults worldwide are obese; a 6-8 percent body weight reduction may decrease the danger of several illness categories, such as hypertension and diabetes, significantly. There is ambiguity among healthcare experts on the best method to accomplish this fat-reduction objective: a 10 percent weight loss in overweight individuals is often recommended. While nutritional therapy, varying degrees of performance, and multidisciplinary therapy are all successful treatments for obese and overweight individuals, many prefer a minimally invasive therapy that strengthens the need for gastrointestinal endoscopy and thus advances gastroenterologic techniques.
Several types and brands of intragastric balloons are currently in service throughout the world, and the expertise is also among its most developed, with reports from six to ten years of balloon duration. The crux of it all is that intragastric balloon technology and expertise are gaining importance on a global scale. However, it is critical to distinguish between the patients who would benefit from the intervention and those who would have an unacceptable risk of experiencing balloon-related problems. Patients with less than grade II obesity; class I obesity, patients affected with a BMI between 30 and 35 kg/m². The average EWL percent after 6 months is less than 49%, and an average EWL percent after the insertion of an endoscopic balloon of more than 45% at 3 months correlated with 55.6% of recovery within 1 or 6 months.
Mechanism of Action and Types of Gastric Balloons
Gastric balloons that are placed within the stomach promote weight loss by acting as space-occupying volumes in the stomach, and as such, they impart a feeling of early satiety and induce a reduction in caloric intake. The reduction may involve increased resting activity of the hypothalamic-pituitary axis anorexigenic “satiety center,” leading to an increase in releases of adrenocorticotropic hormone and possibly gastrointestinal peptides such as cholecystokinin and peptide YY. Several balloon types are marketed, differing in design such as their shape, texture, and folding pattern, made of different materials such as silicone or polyurethane; filled with saline or air, and insertion methods such as orogastric or introduction using a swallowable capsule and later saline filling.
Different methods of endpoint marking are used to reduce the risk of balloon rupture and/or blockage of the intraluminal tube. Currently available balloons in standard clinical practice are those designed to stay in the stomach for 6 months, or more recently, for 1 year. The success of gastric balloons strongly relies on patient selection and compliance with pre- and post-procedure guidelines, as good adherence to the recommended diet and physical activity, regular medical supervision, and weight control. Treatment outcomes may therefore differ considerably from one patient to another, and the best-suited candidates for balloon therapy could differ from one type of balloon to another regardless of BMI cut-offs. Conversely, those patients at highest risk of treatment failure could benefit more from the innovative balloons. Although comparative data between the two anti-reflux or easily removable types of balloons are not yet available, efficacy and safety data are available for each of these balloon types. The main difference in efficacy appears to rest on the heavier load implanted, with repercussions on the duration of the implanted use. Other differences include performance of the placement and extraction technique, rates of post-placement endoscopy exams for documentation of the absence of damage to the mucosa around the balloon, time of balloon leakage, and cases of balloon extraction.
Efficacy and Effectiveness of Gastric Balloon Therapy
Observation and close scrutiny of the data have been the cornerstone of any responsible investigative endeavor. A proper judgment of the gastric balloon treatment’s effectiveness can be made by discerning the weight loss observed in various studies. The skill and experience of each reviewer should not hinder the transparency of judgment. Most bariatric surgeons and gastroenterologists consider 10% EWL after 6 months and 20% EWL after 12 months a standard yardstick as treatment goals. Furthermore, weight loss at 6 and 12 months and the percentage of weight attained are the most common yardsticks employed in most studies as the assessment criteria for the gastric balloon outcome.
Weight lost through gastric balloons varies from 7.3 to 17 kg over a specified duration starting from 6 weeks to one year. The mean net weight reduction was recorded after excluding the balloon’s weight at time zero. At the end of one year, an average of 11.1 to 9.2 kg after the first balloon insertion and 10.6 to 10.1 kg after 6 months was recorded following the second balloon insertion. The net average percent weight lost at the 12th month was recorded between 9.4 to 7.3 kg, corresponding with 10.3 to 7.8% (range 7–12 months). The highest recorded weight loss was at the end of the 6th month, averaging 14 kg. Those achieving weight loss greater than 15% and 20% are also notable, as this marked percentage improvement will have an immense impact on a patient’s quality of life. The percentage of total body weight lost by the time the balloon is extracted at 6 months is 6 to 14%. The net total body weight percentage for the two balloon insertions is in the approximate range of 13 to 14%. The skill and attitude of a patient, support received, attendant psychological symptoms, co-morbidities, and a comprehensive approach towards lifestyle adjustment are contributors to effective and efficient gastric balloon therapy. The use of an algorithm in the selection of candidates for the treatment is recommended.
Safety and Complications of Gastric Balloon Insertion
Currently available double-blind randomized control studies and meta-analyses have demonstrated that intragastric balloons are generally safe and well tolerated, with the majority of adverse events being mild to moderate and predominantly occurring during the first week after insertion. The most common side effects are nausea, vomiting, and abdominal pain. Inflating the balloons with less volume and improving the quality of sedation or analgesia shows promising benefits in reducing the existing side effects. As for severe adverse events, the most feared, although very rare, are gastric perforation with the potential for peritonitis, sepsis, or death, and balloon rupture, which can be life-threatening by triggering mediastinal spread of saline and causing hemodynamic decompensation in the case of high balloon volume. Used without the necessary precautions, intragastric balloons may have a significant potential to cause serious complications.
As for symptoms or serious complications, a comprehensive evaluation of patients in whom an intragastric balloon is planned is suggested. It should include taking a detailed history to identify possible gastroenterological pathologies or regular intake of ulcerogenic drugs and a personalized physical examination to identify typical signs, in particular, signs of bile acid malabsorption as potentially dangerous situations for acute procedural toxic ileitis, mainly during the deflating process. Important is also the evaluation of coagulation parameters, even if mild alterations do not pose a contraindication to the procedure, as only one study showed a significant association between alterations of coagulation parameters and early intragastric balloon-related endoscopic removal due to intolerance. Good sedation and analgosedation, as well as synergy among the endoscopist and the anesthesiologist, are crucial to limit patients’ perception of pain and anxiety, and keeping them well is mandatory for an easier insertion and a lower risk of immediate removal due to the onset of generalized abdominal pain or upper-digestive bleeding. Treatment for agitation or anxiety related to balloon insertion, which is mainly based on verbal reassurance and intravenous use of anesthetics or sedative-hypnotics, is strongly recommended. In general, relief of adverse symptoms is typically within the first day, and if possible, patients should complete an antiproton pump inhibition along with an antiemetic and a prokinetic. In case of gastric retention, if the balloon does not pass naturally, fifteen minutes of endoscopic repositioning in the stomach is suggested to help facilitate this process. After the procedure, precise indications aimed at facilitating the display of eventual adverse symptoms or complications are fundamental, including the use of a specific card indicating whom to seek for healthcare provision. In case of emergency before the possibly necessary exams, a contrast-enhanced CT scan should be performed to rule out gastric wall damage. After balloon placement, short-term clinical follow-up visits are necessary, whereas for durable and long-term quality of life, the surgical, endoscopic, and follow-up care should be expanded.
Future Directions and Emerging Technologies in Gastric Balloon Therapy
Several new gastric balloon designs and materials are a significant advance to optimize patient comfort with a lower adverse event rate that are matched to the physiology of gastric filling. Among these is the Elipse balloon used in the present study. Future directions and emerging technologies in gastric balloon therapy for obesity also include the use of adjustable balloons, which have been developed to assess the role of patient tolerance and outcomes when the size of the balloon is systematically adjusted after placement. Other applications include conceptually intriguing smart balloons, i.e., nonsystematic balloons that help to create potentially beneficial gastric distension that can be sustained within an individual patient’s tolerance without causing intolerance. This has the potential to change and enhance treatment outcomes through an individualized approach and assist in decreasing adverse events. Further advancements, applications, and potential benefits of gastric balloons correspond to ongoing research titration techniques, such as a swallowable asset, a pulmonary artery sensor-based balloon, which can adapt the flotational dead space according to eating behaviors.
Other emerging areas of interest in the gastric balloon field include developing personalized therapy approaches to enhance treatment effectiveness. These are both in a population subpopulation grouping and with the consideration of individual patients’ best weight loss maintenance strategies, which typically occur over the long term. In this area, given the potential complementary activities of naltrexone and bupropion and metabolic or gastric balloon devices, combined trials could be of interest, building on the relatively well-known, safe profile of these pharmacotherapies. These research activities can potentially increase the therapeutic active duration or lessen gastric discomfort and reduce adverse events in traditional gastric balloon therapies by either affecting an individual’s tolerance to gastric balloons. Overall, the field of gastric balloons remains dynamic, and they continue to evolve in accordance with the changing and developing needs and technologies that can be applied to obesity treatment and the need for alternate therapies in an obesity treatment paradigm.
FAQs
How is the Gastric Balloon Inserted?
The gastric balloon is positioned in the stomach through a non-surgical intervention known as an endoscopy. Ordinarily, the uninflated balloon is guided down the esophagus by way of a thin, flexible tube known as an endoscope, while the patient is under mild sedation. After attaining the right position in the stomach, the balloon is either filled with saline or gas, depending on the type of the balloon. The entire procedure requires almost 20-30 minutes.
How Does the Gastric Balloon Work?
The gastric balloon works because it occupies space in your stomach, therefore making you fuller with less food, which leads to the reduction of portion sizes and the overall intake of calories. The balloon actually helps control hunger by slowing digestion; therefore, it supports weight loss when combined with a healthy diet and a lifestyle change.
How Much Time Can the Balloon Keep in My Stomach?
The usual time approximately taken by the gastric balloon for staying inside the stomach is 6 months. This, however, has to be removed after a certain period of time to avoid possible complications such as deflation or damaging the balloon. Newer types of gastric balloons might stay in place as long as 12 months in specific circumstances, but this depends upon the type used and how your doctor recommends it.
How Much Weight Am I Supposed to Lose with a Balloon?
On average, patients can expect to lose around 10-15% of their total body weight with a gastric balloon. Depending on their ability to follow dietary recommendations and lifestyle changes closely, the outcome of weight loss can vary. Those who are able to incorporate an exercise regimen in addition to the balloon and a healthy eating plan often see better results.
What is the Process Like After the Balloon has Been Placed?
Right after the gastric balloon’s placement, most patients experience nausea and vomiting, also some discomfort of the stomach during the first days, because the body gets used to the balloon. Usually, in a week, such symptoms disappear. You will be recommended to start with a liquid diet, which should be gradually replaced with soft food and then continue with a normal one within several weeks. You will also be given the possibility of healthcare professional support while the balloon is placed for maximization of weight loss and minimization of side effects, including dietary advice.
Regular follow-up visits will be scheduled and, at the end of the prescribed treatment period, the balloon is removed via a similar endoscopic procedure.