Intragastric balloon (BIB) against obesity

Generality

The intragastric balloon (BIB) is a temporary treatment that allows you to achieve weight loss without resorting to surgery.
The BIB (Bioenterics Intragastric Balloon) is a soft and expandable device, which is inserted into the patient's stomach by an endoscopic procedure, and filled there with a sterile physiological solution. The positioning of the balloon is usually performed with the patient in a sedated state, so general anesthesia is not required.
The intragastric balloon partially fills the stomach and induces a feeling of premature satiety. Therefore, the BIB helps to reduce - or in any case to control - the portions of food consumed and, in association with the appropriate behavioral changes, represents a non-surgical method suitable for combating obesity.

What is an intragastric balloon?

An intragastric balloon is a prosthetic device that has been used successfully as an adjuvant for weight loss in moderately obese patients for several years now. The BIB consists of a soft and expandable elastomer material, which is inserted into the stomach with an endoscopic procedure and, subsequently, filled with saline. The intragastric balloon thus filled partially occupies the stomach, leaving less space for the quantities of food or drink ingested. This device, therefore, aims to reduce the feeling of hunger and helps to feel full for longer, even after consuming small meals. Sometimes, the intragastric balloon is used for severely obese patients who need short-term care to reduce their weight to a value that makes them suitable for a more complex and permanent surgical approach, such as a gastric band or gastric bypass. .

Action Mechanism

The basic principle of the BIB consists in the stimulation of the gastric fundus, the upper part of the stomach particularly rich in receptors, which once stimulated by the balloon (or by the physiological gastric dilation induced by food) send the signal of satiety to the nervous system. Furthermore, the partial occupation of the gastric volume also mechanically reduces the quantity of food that the patient is able to ingest.

Indications

The intragastric balloon was designed for people who have not been able to achieve prolonged weight loss by conventional means, such as diet - possibly supported by supplements for weight loss - physical activity and any medications. The balloon is indicated for patients with a high body mass index or who have other diseases related to obesity. The gastric balloon is a non-permanent solution and is usually left in place for up to six months, after which is removed. The technique has also been used successfully to induce some weight loss before subjecting the obese patient to a bariatric surgical procedure. Individuals with only mildly overweight should NOT consider the intragastric balloon as a simple and effective solution to lose weight, rather, they should insist on addressing their problem with diet and exercise.

Contraindications

Intragastric balloon placement may not be suitable for patients with:

• Any inflammatory disease and condition of the gastrointestinal tract, such as: inflammation of the esophagus, ulceration of the stomach or duodenum, gastroesophageal reflux disease, chronic intestinal inflammation, stricture of the esophagus or throat, tumors or a tendency to gastritis (balloon may worsen the condition and cause excessive bleeding);
• Conditions that predispose to bleeding (for example: varicose veins) or suffer from bleeding disorders;
• Hiatal hernia> 4-5 cm;
• Previous gastric surgery;
• Patients with severe liver disease;
• Alcoholism or drug addiction;
• Patients on long-term anticoagulant therapy or with gastric-damaging drugs;
• Women who are pregnant or breastfeeding.

Other contraindications to the BIB positioning intervention are:

• Crohn's disease (increases the risk of intestinal obstruction);
• Patients taking non-steroidal anti-inflammatory drugs (for conditions such as osteoarthritis);
• Psychiatric or psychologically unstable patients (the high incidence of intolerance in these subjects makes premature removal of the BIB necessary);
• Patients with binge eating disorder (Binge Eating Disorder, BED, is a predictor for negative method outcomes).

The procedure

After sedation of the patient, the deflated intragastric balloon is inserted through the mouth and esophagus directly into the stomach, just like when performing a gastroscopy. The surgeon can initially look at the stomach through an endoscopic camera and, if no abnormalities are present. that could influence the intervention, proceeds with the positioning of the device. The swallowing process is made easier with the help of a spray anesthetic, applied locally to numb the throat area. Once the balloon is in the correct position in the stomach, it is immediately filled with sterile saline. through a small filling catheter attached to the balloon. The catheter is then gently removed by pulling on the outer end. The BIB closes automatically, as it is equipped with a self-sealing valve. The filled balloon is too large to pass into the intestine and will be able to float freely in the gastric cavity.
The duration of the procedure varies, but generally takes about 20-30 minutes. The purpose of this mass is to produce an "artificial" feeling of satiety in the stomach and reduce the patient's ability to consume large amounts of food or liquid during a meal. The BIB system is a relatively minor intervention, but it may take some time for the stomach to get used to the device. Usually, the patient is able to go home the same day or after a short period of monitoring. The competent specialist is able to provide support and advice after surgery, as well as define the best course of treatment, evaluate weight loss and verify the patient's tolerance towards diet.

Note. A variant of the BIB is called the Heliosphere Bag (BAG, Heliosphere Air Filled Gastric Balloon) and consists of a balloon made of an inert biocompatible material, filled with air.

Recovery after surgery

Immediately after the insertion of the intragastric balloon into the stomach, it is necessary to limit the intake of fluids by mouth, which will therefore be administered intravenously and gradually replaced with the normal intake by mouth. The first few days can be associated with some discomfort: for many patients, it is common to experience nausea, vomiting, bloating, diarrhea and cramps, until their body fully adapts to the presence of the intragastric balloon. Symptoms can last up to two weeks, and some medications may be prescribed to help relieve them. For the first three days following the procedure, all patients are strictly limited to a liquid diet, namely: water, juice, milk or soup. Gradually, the ability to tolerate solid foods should improve, although the volume of food the patient is able to consume in a single intake should be substantially reduced and appropriate dietary guidelines should be adhered to. Depending on the level of nausea. , the patient can be discharged the day after surgery or after a longer hospital stay (about 2-4 days). In the first few days of recovery, patients are advised to avoid any activity that could cause excessive pressure or trauma to the abdominal area. Some people may not be able to tolerate the balloon for the entire period (equal to six months) and, when this happens, the device will have to be removed sooner than agreed. There is a possibility that this intolerance may also occur in the first few days. after balloon placement, especially if side effects (including nausea and vomiting) do not resolve or become more severe than expected. After surgery, patients can return to work after approximately 7 days of rest, but will have to abstain from any physical exercise for at least 8 weeks.

Results

The weight loss you get is variable and can be quite rapid initially. Indicatively, the average weight loss obtained in the 6 months of maintaining the intragastric balloon is about 15-20 kg. Ultimately, the extent of weight loss depends on the patient's compliance, that is, on the degree of adherence to a controlled diet and a program that allows you to change your lifestyle, starting with the practice of regular physical exercise.

Removing the balloon

The BIB can be used for up to six months, longer periods are not recommended. Over time, in fact, the acid content of the stomach tends to weaken the material that makes up the balloon and can deflate it. If it is deemed necessary to use the intragastric balloon for more than 6 months, the patient may undergo replacement surgery. While maintaining the BIB in place, it may be necessary to follow oral drug therapy to reduce stomach acidity. This can lower the risk of stomach irritation and damage to the balloon.
At the end of the initial 6-month period, the competent surgeon can evaluate the options for the next phase (replacement with a new BIB or surgical procedure). The intragastric balloon is normally removed in the same way it was placed, through the esophagus and mouth. Before removal, a sedative and local anesthetic are administered to numb the throat. Using an endoscopic camera the doctor will introduce a catheter through The balloon is then punctured and once deflated, it can be grasped with forceps and removed from the stomach.

Benefits

Compared to a gastric bypass or gastric band operation, the insertion of the balloon into the stomach has the following advantages:

• The technique is less invasive and generally does not require the patient to undergo surgery under general anesthesia;
• The procedure is much less expensive, because it does not involve anesthetics or prolonged hospitalizations;
• The procedure is easily reversible;
• Many patients achieve satisfactory weight loss during the period (approximately 6 months) that the intragastric balloon is kept in the stomach, provided they follow a reduced calorie diet and regular physical activity.

Disadvantages

All medical procedures have some drawbacks and can cause side effects; this rule does not escape the positioning of the intragastric balloon, which however presents a lower risk of complications compared to other more invasive bariatric surgery.

Risks

On rare occasions, the intragastric balloon can deflate and / or migrate through the stomach and intestines. In this case it will be easy to detect, as the saline contains a dye (methylene blue) which facilitates early identification through a change. urine color. The patient should seek immediate medical assistance for balloon removal, as a damaged or deflated device can lead to gastrointestinal erosion or obstruction, which can have very serious consequences. Although intragastric balloon placement procedures are performed regularly without complications, it is very important that all candidates are fully aware of the benefits and potential risks before undertaking this type of surgery.