Gastric Sleeve or Gastric Balloon: Which to Choose?

Obesity: An Increasingly Prevalent Disease

Today, obesity is a major issue in Western countries due to increasingly sedentary lifestyles and high consumption of high-fat, high-calorie foods. Lack of exercise, frequent consumption of junk food, and binge eating (consuming large quantities of food for comfort) are the main factors leading to obesity. Obesity is measured using the Body Mass Index (BMI), which not only places the patient on a scale but also helps assess the associated risk level. The higher the risk level, the more complications obesity can cause for the patient.

What are Gastric Sleeve and Gastric Balloon?

Gastric Sleeve

The gastric sleeve is a surgical procedure that aims to restrict the size of the stomach. This operation is performed laparoscopically and involves the resection of a large portion of the stomach using mechanical sutures. The new stomach has a tubular shape and a considerably reduced capacity of approximately 100/150 ml. It's important to note that this procedure is irreversible because a part of the stomach is permanently removed.

Gastric Balloon

The gastric balloon is an elastomer prosthetic device with unique mechanical properties due to its high flexibility. It is endoscopically introduced into the patient's stomach and filled with saline solution, thus reducing the space available for food and drink. In this way, it can help control caloric intake and promote weight loss.

Bypass or Sleeve

Two of the most frequently used surgical interventions to treat morbid obesity and its comorbidities are gastric bypass and sleeve gastrectomy. Gastric bypass involves creating a small gastric pouch at the top of the stomach connected directly to the small intestine. This technique reduces stomach capacity and alters food digestion, leading to weight loss. Sleeve gastrectomy, on the other hand, aims to reduce the size of the stomach by removing a large part of it, leaving a small, tube-shaped gastric pouch. Both methods have comparable success rates in terms of weight loss, but gastric bypass may be more effective for patients with type 2 diabetes and other metabolic disorders. However, this procedure is more complex and carries a higher risk of complications compared to sleeve gastrectomy. It is crucial to discuss with your medical team all the implications, advantages, and disadvantages of each procedure to determine which one is best suited for you.

How do Gastric Sleeve and Gastric Balloon Work?

How the Gastric Sleeve Works

With the modification of the stomach's size, the gastric sleeve allows for:

• Reduced gastric capacity: a dessert plate to half a full plate;
• Ghrelin reduction: it facilitates the emotional control of "exaggerated hunger" (when the patient is full, they don't want to eat more);

The digestive process proceeds normally: all types of food can be eaten, and everything that is eaten is absorbed. It is not necessary to take vitamin supplements for life. Bowel transit is normal.

How the Gastric Balloon Works

The operating principle of the intragastric balloon is partly comparable to that of the sleeve because, in both cases, there is stretching of the stomach walls. In the case of the sleeve, this is due to a reduction in overall tissue, while in the case of the intragastric balloon, it simulates a filling of the stomach, without this corresponding to the actual amount of food to be assimilated. The stretching activates mechanoreceptors that are responsible for the feeling of satiety. Over the last fifteen years, endoscopy has greatly evolved, and the use of the intragastric balloon has become an increasingly used and effective solution in the fight against severe obesity.

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What are the Advantages and Disadvantages of Gastric Sleeve and Gastric Balloon?

Advantages and Disadvantages of Gastric Sleeve

Here are the main advantages of gastric sleeve:

• The stomach functions normally: food enters, is digested, and exits;
• Allows you to eat all types of food;
• Everything that is eaten is absorbed: no loss of vitamins or trace elements;
• Operation with little medical dependence;

However, gastric sleeve also has some disadvantages. Here are the main ones:

• High-calorie and easily digestible foods such as ice cream, sweets, etc., reduce the effectiveness of the treatment;
• Risk of dilation due to repeated abuse by the patient over the years;
• Possibility of gastroesophageal reflux over the years. However, this is a fairly rare complication;
• Patients with a very high BMI may need a second operation with malabsorption (Bypass);

Advantages and Disadvantages of Gastric Balloon

For weight loss, choosing a gastric balloon instead of a gastric sleeve or gastric ring offers the following benefits:

• This method is less invasive and does not usually require surgery with general anesthesia for the patient;
• You can save considerably by opting for this procedure, which requires neither anesthesia nor a prolonged hospital stay;
• The procedure is easily reversible;
• By following a low-calorie diet and engaging in regular physical activity, many patients manage to achieve satisfactory weight loss during the period of approximately 6 months when the intragastric balloon remains in place in the stomach;

It is important to keep in mind that all medical interventions have their drawbacks and can cause side effects. Although placing a gastric balloon is no exception, the risks of complications are lower compared to other more invasive surgical operations for weight loss.

Gastric Balloon: The Non-Invasive Solution to Moderate Obesity

Bariatric surgery is sometimes the only option for the most severe cases, but there are also endoscopic treatments for less severe cases. Based on the same principles as bariatric surgery, bariatric endoscopy specializes in minimally invasive interventions using minimal devices or sutures to reduce gastric volume. Similarly, bariatric surgery includes "restrictive" interventions such as gastric banding, gastric bypass, and sleeve gastrectomy, which aim to decrease stomach volume. However, for cases that are not yet severe, endoscopy also offers treatments for this condition. Based on the principle of emulating the effects of bariatric surgery, bariatric endoscopy specializes in minimally invasive interventions for the application of devices, or minimal sutures, aimed at reducing gastric volume. The same applies to bariatric surgery in the case of so-called "restrictive" interventions. In surgery, we have, in this typology of interventions, gastric banding, gastric bypass, and sleeve gastrectomy which aim to reduce the volume of the stomach. In endoscopy, we find rather endoscopic vertical gastroplasty, gastric aspiration, and the intragastric balloon. In this case as well, although these are minimally invasive techniques, in the case of gastroplasty and aspiration, there is a sectioning and suturing operation. In the case of the gastric balloon, on the other hand, via the endoscopic route, only a balloon is placed in the stomach. No sutures or sections during treatment with the intragastric balloon, therefore. The intragastric balloon placed in the stomach aims to induce a feeling of satiety before the organ is completely full. This, combined with a resumption of healthy eating habits (and smaller portions), promotes a tool for combating obesity in patients who are moderately obese.

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