Gastric Balloon
The Gastric Balloon is a non-surgical procedure available for weight loss in many countries. While gastric balloon procedures generally cost less than other weight loss procedures, the FDA has not approved of the procedure in the United States. The balloon is effective in temporarily reducing hunger, controlling food intake, initiating behavioral (lifestyle) change, and achieving target weight loss of 10 to 25kg. This procdure is also called Toga (for transoral gastroplasty)

What is the gastric balloon?
The gastric balloon is a soft, silicone balloon that is inserted into the stomach and filled with sterile saline (salt water). When the balloon is filled (inflated) it stretches the stomach wall producing a feeling of satiety – or flack of hunger.. Additionally, because the gastric balloon fills a significant portion of the stomach, patients use smaller portion sizes, which means fewer calories!

How is the balloon implanted?
Placement of the balloon takes approximately 20-to-30 minutes to perform by a team of qualified gastroenterologists. Because the balloon is inserted and removed in a day clinic and does not involve surgery, it is considered to be a minimally invasive procedure.

The doctor passes a special endoscope (camera) through the mouth, down the gullet and directly into the stomach. This is done to ensure no abnormalities are present and it is safe to insert the gastric balloon. Once the physician has determined everything is okay, he or she will pass the deflated gastric balloon into the stomach. To ease discomfort, the doctor might offer a local anesthetic to numb the throat to make it easier to swallow. In some cases, muscle relaxants are also used to sooth throat muscles.

Once the gastric balloon is inside the stomach, it is immediately filled with sterile saline through a small filling tube (catheter) attached to the balloon. Once filled, the doctor removes the catheter by gently pulling on the external end. The balloon has a self-sealing valve and at this point it is floating freely in the stomach. Physicians also add a specially made green dye so that in the event of the balloon leaks or ruptures, the patient's urine will change color, thereby alerting them to visit the doctor.

Because there is no general anesthesia involved in this weight loss procedure, the patient is observed for a short time, he or she is free to leave the hospital in one or two hours.

Gastric Balloon Diet
The physician will give each patient instructions of what patients can eat or drink for the first few weeks after the procedure. The first week a liquid diet will be recommended with instructions to drink lots of water. After the first week, the dietician will recommend solids. Patients will receive instructions on your initial solid-foods nutrition regime with calorie restrictions. Eat slow and quietly, divide food into small amounts. Remember this procedure is meant to incite a modification in eating habits and lifestyle change. The gastric balloon gives patients a window of opportunity to adapt to the lifestyle changes they need to make in order to maintain the lost weight after the balloon is removed.

How long does the balloon stay in?
The gastric balloon can stay in place for a maximum of 6 months, where it is then removed the same way it was placed. Most of the weight loss occurs in the first 4 months. The balloon will be removed in a 20-minute procedure similar to that of the placement.

How much weight will patients lose?
Patients who have the gastric balloon implanted can expect to lose around 35-40% of excess weight, which in most cases results in a weight loss of 30-50lbs (15-20kg). Heavier patients may lose substantially more than this.

What are the health benefits?
The health benefits are those associated with any method of weight loss, including an improvement in diabetes, hypertension (raised blood pressure) and sleep apnea. There are also major improvements in mobility and self-esteem.

What are the long-term benefits?
After the removal of the balloon or its spontaneous evacuation, weight-regain is possible. There is thus a relative long-term ineffectiveness, which explains that this device is not reimbursed in most countries. In some cases, weight-loss is not sufficient, or is impossible to stabilize because the patient has not changed his former eating-habits.

Long-term results are not currently available in order to assess the efficiency of the balloon, and more prospective studies are mandatory. Hence, it should be understood that this procedure is meant to incite a modification in eating-habits, and that it is pointless if there is no diet support. In no way it can be regarded as an ultimate solution for obesity.

A recently published study looked at what happens to patients one-year after the gastric balloon was removed. At the time of removal average weight loss for the 100 patients in the study was 12 kg (40% excess weight). One year later, mean weight loss was 8.6 kg (26% of excess weight). A further study of 140 patients with a follow-up of up to 30 months, found that 40% of patients maintained a weight loss of 25% excess weight or above.

What Are The Risks?
The gastric balloon procedure itself is simple and serious complications are uncommon.

If the balloon ruptured it will usually pass through through the bowel and be expelled quite naturally. However, in rare cases it may cause intestinal obstruction (blockage of the bowel). If this occurs, surgical or endoscopic removal would be required. Bleeding or perforation of the oesophagus or stomach could occur during the balloon insertion or removal, requiring surgical correction. Gastric discomfort; nausea and vomiting are common for the first few days following balloon placement. A feeling of heaviness in the abdomen, abdominal or back pain, gastro–oesophageal reflux or indigestion have also been reported.

Availability
As mentioned, the FDA has not approved of the procedure in the United States. Those who wish to undergo the procedure need to travel outside of the country. The Gastric Balloon is available in Brazil.

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