What is an endoscopic gastric balloon?
Obesity, which is one of the most important problems of our age, is not only a cosmetic problem, but also brings with it many diseases that shorten the life span of the person. Obesity is accompanied by many diseases such as hypertension, diabetes, sleep apnea and bone diseases. In the past, in the treatment of obesity, a lifestyle change was made in which the calorie intake was reduced and the calorie intake increased. However, this was not a completely sustainable method for everyone. Studies show that lifestyle changes are not effective in some patients, and that some patients regain their weight after 2 years.
Then, with the reflections of the developing technology in the field of health, surgical methods came to the fore. Surgical methods such as sleeve gastroplasty, sleeve gastrectomy, gastric sleeve and bypass surgeries provide effective and sustainable weight loss. However, patients who do not want to have surgery prefer endoscopic methods. Effective results can be obtained in gastric balloon application, which is the most preferred method among the methods performed endoscopically, that is, by entering orally. In this method, a balloon is placed in the stomach of the patient through the mouth. The balloon is then brought to a certain volume. In this way, a substance that fills the stomach is placed and the movement of the stomach is disturbed. Thus, the appetite of the patients decreases and their food capacity decreases. Since they are difficult to digest after eating, the portions of the patients are reduced and the number of meals is increased. Another advantage is that it is a reversible method. In other words, when the patient is not satisfied with the procedure for any reason, the gastric balloon can be easily removed again. Today, there are gastric balloons that can stay up to 1 year.
In addition to the types of balloons filled with air or liquid, there are also balloon types that can stay for 6 months or 1 year. These decisions are determined according to the patient's criteria after the first evaluation of the patient by the physician. The most important issue in terms of the effectiveness and sustainability of gastric balloon application is the lifestyle change of the patient. If the patient does not reduce the calorie rate after the procedure and does not make sports a part of his life, it is not possible for the success to be sustainable even if the desired goals are achieved in practice. For this reason, endoscopic balloon treatments are accepted as a method with successful results with experienced physicians and patients who really set their minds on losing weight.
Who is the endoscopic gastric balloon applied to? In which diseases is it used?
According to the World Health Organization, if the body mass index is above 30, treatment is required. Endoscopic gastric balloon is applied directly to obese patients with a body mass index above 35. It is applied to patients with a body mass index above 30 if they have concomitant diseases. Obesity treatment is recommended, especially if there are concomitant diseases such as diabetes, sleep apnea, and blood pressure. At first, endoscopic obesity treatments were found to be a bridging treatment for patients with a body mass index above 40, who definitely needed surgery but who had a high risk of surgery, and who were in poor general condition. In the process, a gastric balloon is attached to the patient first, and the patient falls below a certain weight threshold. Pulmonary and cardiac functions improve. The risk of anesthesia is reduced. Then it becomes ready for surgery. When it is suitable for surgery, the balloon is removed and the surgery is performed. In summary, endoscopic obesity treatments are appropriate in patients who are obese, have concomitant diseases that cannot be controlled, and patients who need to be prepared for surgery.
How is the endoscopic gastric balloon applied?
In the first evaluation, it is checked whether the patient has an eating disorder or a psychiatric problem. It is evaluated whether there is a condition called binge eating syndrome. For example, it should be known that not only endoscopic but also none of the obesity treatment methods may work for a patient who opens the cabinet and puts something into his mouth while passing by the refrigerator or cannot stop without taking a bite from the pot while passing in front of the oven. Neither pharmacological treatments, nor endoscopic treatments nor surgical treatments may work in these patients. Therefore, these diseases should be distinguished first. If there is an underlying psychological problem, it must be resolved first. For this reason, in the first evaluation, it is necessary to determine whether the patient has an eating disorder or not, by making an evaluation with a psychiatrist. Secondly, the patient should aim to lose weight. Endoscopic treatment phase is discussed with patients who fulfill these conditions. The patient is told how the procedure is performed and what awaits him. Then, it is investigated whether there is another disease that causes the patient to gain weight. For example, the patient may be gaining weight due to an ailment related to the adrenal glands or thyroid. In summary, the patient with internal disease is also evaluated in terms of If there is no pathological weight gain problem, the patient is a candidate for endoscopic obesity treatment. The patient is then prepared as if preparing for a normal endoscopy procedure. He comes to the endoscopy unit on an empty stomach. Endoscopy is performed while asleep under sedation. What is important in endoscopy is whether the patient has gastric hernia, whether there is a serious esophagitis, whether there is an active ulcer in the stomach. In addition, cancerous lesions that may occur incidentally in endoscopy are investigated. In patients who do not have a problem in this respect, a gastric balloon can be inserted in the same session. The placement of the gastric balloon takes 5-10 minutes. Then the patient is awakened. There is no problem in the patient for 6-7 hours. Then the nausea starts. It is intervened with some medical treatments and anti-nausea drugs. Within a few days, the patient's nausea becomes completely normal. However, it is not possible to switch to normal nutrition immediately. First, a liquid diet is applied for 1-2 days. After the 3rd day, puree is applied and after the first week, normal nutrition is started.
Frequently asked questions about the endoscopic gastric balloon
Are there risks of endoscopic gastric balloon?
This procedure is no different from any endoscopy procedure. If it is performed by an inexperienced endoscopist, there may be risks such as perforation or bleeding. However, this is a low probability. In the past, after the balloon was inflated by endoscopy, it could cause bleeding, ulcers and gastric perforation in old-style balloons. However, the risk of bleeding and tearing in the new balloons used today is very low and almost nonexistent. However, there are some situations that await the patient after the procedure. Because as a result, a foreign body enters the body. This object is inflated to 400-600 cc. For this reason, the body tries to throw it out in the first 1-2 days. With nausea, vomiting, retching or increased bowel movements, the body tries to expel this object. This tolerance phase lasts for 1-2 days. In summary, complications are almost non-existent if they are performed by a competent physician and the appropriate method is selected for the appropriate patient.
What happens if the endoscopic gastric balloon bursts?
The probability of a gastric balloon bursting is almost non-existent. In the past, such problems could be experienced in old-style balloons. If the endoscopic gastric balloon bursts, it must be removed. If not removed, it may cause intestinal obstruction. However, today a system has been developed for this. Although there is no problem of bursting in new type balloons, the balloon is inflated with blue water for safety reasons. In this way, if the balloon bursts, the patient's urine color turns blue. Since the patient will report this to the physician without wasting time, the patient can be intervened before the balloon leaves the stomach. If the patient does not notice the color of the urine and the balloon goes to the small intestines, some symptoms may be experienced due to the obstruction of the small intestines. Sometimes the patient may unwittingly remove the balloon through defecation. However, these are very unlikely risks.
How to apply a swallowable gastric balloon?
For patients who are afraid of endoscopy, a newly found method, swallowable gastric balloon application, is pill-shaped gastric balloons inserted without an endoscope. In this method, a small capsule is swallowed by the patient. It is inflated from the outside with the cable to which the capsule is attached. The location of the balloon is adjusted under the xray device. The cable is removed and the balloon bursts on its own after 4 months and can be thrown out naturally.
At what weight is the gastric balloon inserted?
It can be applied directly to patients with a body mass index above 30 and accompanying comorbid diseases (diabetes, hypertension) or patients with a body mass index above 35. There is also an age limit of 18 years.
Are there any gastric balloon damages?
In the studies performed, no complications other than nausea, vomiting and retching have been shown for the first 1-2 days in new generation balloons. There were complications such as ulceration, perforation and bleeding in the stomach in old-style balloons. In the new type of balloons, these are almost non-existent.