Gastric Balloon: Indications and Contraindications

Who is a gastric balloon indicated for?

Patients with a BMI over 30 but under 40

The gastric balloon is not suitable for everyone. There are clear indications as to who can and cannot have it inserted.

Generally, the bariatric surgeon proposes the gastric balloon to patients who have been obese for at least five years and who have followed a well-supervised and protected course of dietary attempts and psychological support. When the healthcare team recognizes that the patient cannot find an effective solution on their own and has a body mass index greater than thirty (BMI > 30), the gastric balloon is truly the first minimally invasive step that can help them lose weight. The gastric balloon helps the patient eat less; the patient feels supported because they have "internal help" even though they don't have to delegate their willpower to the balloon.

Patients with a BMI between 40 and 50

We said that the BMI was greater than 30, but doctors tend not to exceed 40 or at most 50. However, there is also the possibility of placing the gastric balloon in patients whose BMI is between 40 and 50 (40< BMI <50), or even more, as a transitional therapy, i.e., as a bridge to bariatric surgery. Indeed, patients with a BMI greater than 50 (BMI > 50) inevitably present higher risks in terms of anesthesia and a greater possibility of post-surgical complications. In these cases, the intragastric balloon will aim to help the patient lose those 10-15 kilos, the loss of which is able to place the patient in a lower risk class in order to be able to begin real bariatric surgery.

A patient with a high BMI may also undergo placement of a gastric balloon if it is proposed for major surgery, not necessarily bariatric. Therefore, the surgeon could possibly place a gastric balloon in this case as well, in order to reduce anesthetic and post-surgical risks.

Generally speaking, the gastric balloon allows for good success, i.e., patients who easily lose 20 kilos and who gradually get used to improving their behavior towards food and their lifestyle.

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Are there any contraindications to gastric balloon insertion?

Relative contraindications to the gastric balloon

There are relative contraindications to the gastric balloon, which are problems that, if resolved, allow the device to be placed in the gastric cavity. For example, severe esophagitis: once it has been resolved by good gastroscopic control showing total resolution of the mucosal damage, it is possible to place the gastric balloon.

Similarly, a gastric ulcer, which is not neoplastic, or a duodenal ulcer that heals completely, or a bleeding duodenal ulcer or a gastric ulcer that can heal.

Absolute contraindications to the gastric balloon

There are also absolute contraindications to the gastric balloon. The most important is that the patient has a large hiatal hernia, greater than 5 cm. This creates difficulties in the method and could predispose to complications in case of rupture of the balloon or other problems with the device.

Another contraindication is the presence of previous resection surgery at the level of the esophagus and stomach or the presence of Crohn's disease, which can affect the entire gastrointestinal tract, from mouth to anus, by inflammatory, erosive-ulcerative lesions, perforations or fistulas.

Other absolute contraindications to the gastric balloon are the presence of a neoplasm or anticoagulant treatment, for example in a cardiac patient or in any clinical situation for which an anticoagulant has been used.

Furthermore, a patient whose psychiatric pathology does not allow good collaboration, a patient who is too anxious and unable to consciously accept this type of therapy and above all to tolerate it for the six months during which the gastric balloon will be left in the stomach.

Finally, a patient who is alcohol or drug dependent is not considered a good candidate for gastric balloon placement.

Alternative Treatments

In addition to the gastric balloon, there are several alternative treatments for weight loss, including sleeve gastrectomy and gastric banding. Sleeve gastrectomy, also known as sleeve gastrectomy, involves removing a large portion of the stomach, reducing its capacity and limiting the amount of food the patient can consume. This procedure is irreversible and generally leads to significant weight loss. On the other hand, gastric banding is a less invasive method where an adjustable band is placed around the upper part of the stomach to create a small pouch. This band can be tightened or loosened to control the amount of food the stomach can hold, thus helping to reduce appetite and food intake. Both options have their own advantages and considerations, and the choice of treatment should be made in consultation with a healthcare professional to determine the best approach based on the patient's individual needs and goals.

What are the side effects of the gastric balloon?

The side effects of the gastric balloon can vary from person to person, but some are relatively common. Among the immediate side effects, patients may experience nausea, vomiting, and abdominal pain in the first few days after balloon insertion. These symptoms are usually temporary and subside as the body adapts to the presence of the balloon. In the longer term, some patients may experience gastroesophageal reflux, bloating, or persistent discomfort. In rare cases, more serious complications such as ulceration of the stomach wall or balloon migration can occur, requiring medical intervention. It is important that patients discuss potential risks in detail with their doctor before choosing this weight loss method.

How is the gastric balloon inserted?

In practice, the patient undergoes a routine gastroscopy, one or two months before the gastric balloon is placed to ensure that everything is in order and that there are no potential problems to treat. On the day of gastric balloon insertion, the patient is taken to the operating room, where a further gastroscopy is performed, then the deflated silicone balloon is inserted. Once it has reached the gastric cavity, it is inflated in a lying position with physiological saline in a variable quantity of 500 to 750 cc, to which 2 cc of methylene blue dye will be added. Indeed, during the months that the balloon remains in the gastric cavity, it may rupture, although this is rare, without the patient having any major problems, or even without noticing it. The dye, which is totally inert and harmless, is added precisely so that the patient can see if the balloon has ruptured, thanks to the blue coloration of the urine. This is an unequivocal sign that the balloon is no longer intact.

Once filled, the gastric balloon is left in the gastric cavity with a slight pull under the cardia (exit of the esophagus towards the stomach). The patient, who has been admitted the day before to be better prepared, will remain in the hospital for 2 or 3 days.

Gastric Balloon Recovery Time

Recovery time after gastric balloon placement generally ranges from a few days to a week. Immediately after the procedure, which is often performed on an outpatient basis, patients may experience nausea, vomiting, and abdominal cramps. These symptoms are temporary and tend to subside as the body adapts to the presence of the balloon. Most patients can resume light daily activities within two to three days of the procedure, although it is advisable to avoid strenuous physical exertion for about a week. During this recovery period, medical follow-up is essential to ensure that the patient is adapting well and to manage any potential complications. Patients also receive instructions on the diet to follow and on the necessary lifestyle adjustments to maximize the benefits of the gastric balloon.

What is the success rate of the gastric balloon?

The success rate of the gastric balloon is generally estimated at around 80%. This means that the majority of patients who opt for this weight loss method succeed in achieving a significant reduction in their body weight. The gastric balloon helps by reducing the stomach's capacity, which decreases appetite and encourages healthier eating habits. However, long-term success largely depends on the patient's commitment to adopting a balanced lifestyle including a healthy diet and regular physical activity. Medical follow-up and nutritional support also play a crucial role in optimizing results and maintaining weight loss.