Intragastric Balloon for the treatment of Obesity.
Intragastric Balloon for the treatment of Obesity.

Intragastric Balloon for the treatment of Obesity.

Intragastric Globe (air filled).

Is a lightweight air-filled intragastric balloon

Most studies were performed using liquid-filled balloons. Air-filled balloons may increase digestive tolerance, efficacy of a new air-filled intragastric balloon in nonmorbidly obese patients. It can be used as a minimallyvasive first step treatment for those with moderate to severe obesity.

There are two main indications for using an intragastric balloon:

1-Pre–surgery for weight loss in severely obese patients to reduce surgical risk.

2-Weight loss in obese patients who have significant health risks related to their obesity and who have failed to achieve and maintain weight loss with a supervised weight–control programme. The patient should have a BMI above 30.

For more endoscopic details download the video clips by
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Intragastric Balloon for the treatment of Obesity

Video Endoscopic Sequence 1 of 13.

Intragastric Balloon for the treatment of Obesity

This procedure is totally ambulatory and does not require surgery.

Placement of IGB is carried out in an Endoscopy Suite. Intravenous conscious sedation is administered and the throat is sprayed with local anesthetic. Endoscopic examination of the upper gastrointestinal tract is performed. The scope is then withdrawn. The IGB in its collapsed state is attached to an introducer tube. This ensemble is introduced into the stomach via the mouth.Once it is in the correct position the IGB is inflated with air the introducer tube detached and removed. The entire procedure takes about 15 or 20 minutes. Patients are carefully monitored during the endoscopic procedure and during recovery until they are fully alert.

Like other weight loss surgeries, the balloon is a tool and works best when it is properly, following a low calorie diet.

Intragastric balloon: a temporary treatment for obesity

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Intragastric balloon: a temporary treatment for obesity

The upper gastrointestinal tract is visualized immediately prior to insertion of the balloon. The diagnostic endoscopy is performed to define anatomy and to exclude concomitant disease which could preclude the safe and effective use of the device. If the stomach is healthy the balloon is introduced into the stomach.

Unlike liquid filled balloons the air filled balloon is very light weighing less than 30g. It will help to tolerate the device much better than traditional liquid filled balloons.

 

 

 

 

 

Intragastric balloons are a temporary non-surgical obesity

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Intragastric balloons are a temporary non-surgical obesity treatment that induces short-term weight loss by partially filling the stomach to achieve satiety and reduce food intake.

Obesity is a chronic metabolic disorder with considerable health risks, which can be approved by a sustained modest weight loss. This can be achieved by medical treatment through behavioral therapy, diet, exercise and pharmacotherapy. Surgery is often needed for the severely obese. Intragastric balloon treatment stands in between, being more drastic than medical treatment but less invasive than surgery.

 

 

 

 

Intragastric balloon: a temporary treatment for obesity

Video Endoscopic Sequence 4 of 13.

Upper Endoscopy Image Showing The Intragastric Balloon

Candidates for IGB.

Patients with moderate obesity (BMI 30 40) which places them at serious medical risk.

Patients with severe obesity (BMI >40) who are awaiting definitive surgery (isolated gastric bypass or gastric banding).

Patients with co morbid conditions which make them high risk for surgery or anesthesia who wish to lose weight.

 

Intragastric balloon: a temporary treatment for obesity

Video Endoscopic Sequence 5 of 13.

IGB Therapy.

The inflated IGB stays in the stomach for a maximum of 6 months during which time patients are followed carefully by our medical specialists. In rare circumstances the IGB may have to be removed before the end of the six months. This can be done at any time. While the balloon is in the stomach the patient will experience a felling of fullness (satiety). Because the balloon takes up a lot of space in the
stomach less space is available for food. This results in smaller meals and the loss of excess weight. During the six months the average weight loss is 35 lbs. (range 12-42 lbs).

Some patients have lost until 60 lbs.

Endoscopic View of Intragastric Balloon

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Endoscopic View of Intragastric Balloon

Is a balloon with a triple shell of air molded silicone and both have polymerized interiors totally biocompatible, that permits a better homogeneity with its thickness. This mechanism reduces to a minimum the possibility of migration. The Gastric Balloon is inflated with air and its maximum weight is between 26 and 28 grams. The life expectancy of the Gastric Balloon is between 6 and 7 months, at which time it has to be removed in the same way it was placed with the help of the gastroscope as an ambulatory procedure.

 

Video Endoscopic Sequence 7 of 13.

Positioning was performed, after diagnostic endoscopy, under unconscious sedation. After placement, the balloon was slowly inflated with 840-960 cc of air, which gives the inflated final volume of 650-700 cc of air, as the air is compressed.

Differences between air filled and liquid filled balloons

The most striking difference is that today the use of liquid filled balloons seems to be on the decline, with many endoscopist turning to air filled balloons instead. While this statement can not be supported empirically, discussions among surgeons who implant Intragastric Balloons seems to bear this out, as most list overall patient comfort as the
primary reason for their conversion. Other reasons that have been cited include:.

Problems with leaking in liquid filled Balloons

— With liquid filled Balloons, the uncomfortable feeling of constantly carrying around 650 grams (1.43 pounds) of weight in your stomach, versus the typically 30 gram weight of an air filled Balloon.

— With liquid filled Balloons, the sloshing feeling that happens when rapid physical movements take place.

 

 Image of Intragastric Balloon

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Endoscopic Image of Intragastric Balloon

It is important to understand that the IGB is an aid to weight loss and must be used in conjunction with a prescribed diet and behaviour modification program. Therefore, the amount of weight lose will depend on how closely follow the diet. How long maintain weight loss will depend on how completely adopt long-term lifestyle changes involving eating behavior and exercise.

 

Endoscopic Image of Intragastric Balloon

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Endoscopic Image of Intragastric Balloon

The Intragastric Balloon is indicated for use for up to six months in patients with a BMI from 30 kg/m2 to 40 kg/m2, who have significant obesity-related health risks.

It is also indicated for use in morbidly obese individuals, defined as those having a BMI >40 or a BMI <35 with serious physiological risks, who refuse surgery or who have a high surgical risk due to their excessive weight.

Weight reduction through the use of the intra-gastric balloon may help to reduce surgical risk before bariatric (weight-loss) or other surgery.

 

Endoscopic Image of Intragastric Balloon

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Endoscopic View of Intragastric Balloon

The intragastric balloon may be useful when obesity is not severe enough to justify bariatric surgery, or when patients refuse surgery.

The intragastric balloon is less invasive than surgery, can be repeated, and is reversible. Consecutive balloons can potentially be placed to extend treatment. The use of a second balloon was followed by significant weightreduction in a period of 6 months.

 

Endoscopy of Intragastric Balloon

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Endoscopy of Intragastric Balloon

Abdominal pain, nausea, and vomiting are common, particularly in the first week after balloon implantation.

Lifestyle intervention, including a combination of low-calorie diet, behavioural modification,and physical activity, is recommended for weight loss. Anti-obesity drug therapy may be used as an adjunct to lifestyle intervention.

 

 

 

 

 

Endoscopy of Intragastric Balloon

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Moderate weight loss may be achieved if patients adhere to a weight-reduction program.

Weight gain can recur when the balloon is removed after six months therefore the patient should be following a diet program.

Obesity appears to lessen life expectancy markedly, especially among younger adults. Obesity increases the risk of premature death from coronary heart disease, stroke, type 2 diabetes, gallbladder disease, and some cancers.

 

Endoscopy of Intragastric Balloon

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The balloon is place immediately after the GE junction.

The advantage to this balloon is that it positions itself to the top of the stomach, where there are receptors that give a sensation of being full.

We have had no complications nether with the placement non with the removal.

 

Endoscopy of Intragastric Balloon

Plain Abdominal Film

This image shows the space that is occupied by the balloon.

Click here to enlarge the image


Intragastric Balloon for the treatment of Obesity.

Video Endoscopic Sequence 1 of 9.

Intragastric Balloon for the treatment of Obesity.

This endoscopic sequence shows the technique to removal this globe.

The balloon is safely removed under exact endoscopic control after 6 months, we advise to be removed no more than 7 months due to a fact that the material that has been manufactured lost consistency because of the gastric acid and become hard. The more time let in placed the more hard to removal. The maximum time a balloon can be left in place is 7 months, after which it must be removed.

dotracheal intubation under general anesthesia. Endoscopist are sometimes unfamiliar with methods of removing these endoscopically placed gastric balloons Physicians who are skilled in performing gastroscopy for obese patients require additional training before they can perform balloon placement and removal.

 

 

 

 

Intragastric Balloon

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Intragastric Balloon for the treatment of Obesity.

A special needle is inserted though the endoscope to deflate the IGB. Once it is fully deflated it is grasped with specially designed forceps and removed via the mouth.

The balloon is punctured using a sharp needle around the device. The needle is then attached to an automatic aspirator which takes 5 minutes to extract all the air out of the balloon before it can be removed.

The extraction must be carry out with the kit of extraction that the manufacturer provides, contains two instruments a flexible sharp needle to extract the air and the other a special grasping forceps.

 

Intragastric Balloon for the treatment of Obesity.

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Intragastric Balloon for the treatment of Obesity.

The globe is deflated using a deflation needle which is used to perforate the Intra gastric globe in the stomach and to remove all the air from the globe via aspiration.

In this video clip it observed several perforations and a suction pump is adapted in its end outside of endoscope which will extract all the air.

 

Intragastric Balloon for the treatment of Obesity.

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The Globe is completely deflated and ready to be removed

 

Intragastric Balloon for the treatment of Obesity.

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Once the globe is completely deflated the extraction technique will be accomplished using a special grasping forceps to extract the intragastric globe from the stomach.

 

Intragastric Balloon for the treatment of Obesity.

Video Endoscopic Sequence 6 of 9.

In order to extract the globe effectively a consistent traction should be maintained while going through the inferior gastro esophageal sphincter, when you reach the upper esophageal sphincter you should maintain the same technique until it comes out. 

 

Intragastric Balloon for the treatment of Obesity.

Video Endoscopic Sequence 7 of 9.

Intragastric Balloon for the treatment of Obesity.

Continuous traction is maintained, we used a dilution of two buscopax diluted in 250 cc of solution which aid to relax the gastroesophagic sphincter.

 

Intragastric Balloon for the treatment of Obesity

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The balloon is coming out from the mouthguard

 

Intragastric Balloon for the treatment of Obesity

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Now the balloon is out.

 

Intragastric Balloon for the treatment of Obesity

The Extraction of the Globe must be carried out in the
operation room with Endotracheal intubation under general
anesthesia.

Download the video clip by clicking on the image.

 

Removal of the Deteriorated balloon

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Removal of the Deteriorated balloon

The air filled balloon that is the one that we used, This made up of three layers the external one is of silicone and two internal are made of polyurethane, which are quite resistant to gastric acids.

This endoscopic sequence shows the extraction of the balloon when this is deteriorated, the balloon is recommended to be retired before the 7 months, because later the balloon loses force, is deflated, the materials that this made are deteriorated and the removal becomes more difficult.

This it is the case of a Salvadoran lady 32 year-old who marriage with a Spanish man, this patient emigrated to the Spanish republic, in 6 months she had increased 35 pounds of weight.
An intragastric globe was placed, after 7 months returning from Spain to the for its extraction, being lost the 35 pounds that had gained previously, the extraction of the balloon was a little difficult since this one was deteriorated enough as if there was been within the gastric camer more than 10 months, the reason perhaps was that she used in the diet of weight loss abundant sherry vinegar in the salads.

 

 

 

 

Endoscopy of intrgastric balloon

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Endoscopy of intrgastric balloon

The present example in this endoscopic sequence it is appraised the extraction of this balloon that is deteriorated and the comparison with previous endoscopic sequence that is almost intact globe that was in 7 months to have implanted. Therefore to avoid the balloon be deteriorated and the procedure be easily removed, it is recommended to retire this balloon before 210 days (7 months). The more time the balloon is in placed the more deteriorated will be, reason why it entails to technical difficulties in its extraction.

 

 

 

Endoscopy of intrgastric balloon

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Endoscopy of intrgastric balloon

More perforation are being performed with the catheter to extract the air. The balloon being punctured and deflated. Once the balloon is deflated is grasped and removed.

Endoscopy of intrgastric balloon

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Endoscopy of intrgastric balloon

The image and the video clip shows completely deflated Globe.

 

Endoscopy of intrgastric balloon

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Endoscopy of intrgastric balloon

We initiate the extraction with this special instrument, never try to extract it with different forceps because is useless.

 

Intragastric Balloon

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Endoscopy of intrgastric balloon

One of the most important step, is to pass the balloon through the cardias, here it is necessary to have something of patience and the traction has to be maintained. like “Fishing a Fish”

Endoscopy of intrgastric balloon

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Endoscopy of intrgastric balloon

In this video clip the balloon is pulled out towards the upper third.

 

Endoscopy of intrgastric balloon

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Endoscopy of intrgastric balloon

The Balloon is in the upper third of the esophagus, where some times it is difficult to extract it, as is in the case presented.

 

Intragastric Balloon

Video Endoscopic Sequence 9 of 14.

The end of the balloon is in the oropharynx, endotraqueal tube is observed, from the balloon emerges, a red liquid which comes within the balloon, since in some times liquids and rest of foods have been introduced within the globe by osmosis.

 

Intragastric Balloon

Video Endoscopic Sequence 10 of 14.

In some times when the balloon is difficult to be removed
from the oropharynx, the balloon that is in the tip of the
endotraqueal tube could be deflated for a short time but be
careful that oropharynx be free of secretion.

 

Intragastric Balloon

Video Endoscopic Sequence 11 of 14.

Returning to take it with this grasping.

Intragastric Balloon

Video Endoscopic Sequence 12 of 14.

We continue negotiating with the upper esophagic
sphincter.

 

Intragastric Balloon

Video Endoscopic Sequence 13 of 14.

The Globe goes towards outside.

.
The Balloon successful extracted

Video Endoscopic Sequence 14 of 14.

The Balloon was successfully extracted

In the present example of this endoscopic sequence it is
appraised the extraction of this balloon that is deteriorated
and the comparison with previous sequence that globe is
intact. Therefore it is recommends to retire this balloon
before 210 days (7 months).

 

Migration of Intragastric Balloon

Migration of Intragastric Balloon

To avoids the balloon migration the removal should be before of 7 months of been implanted. This type of balloon is well safe but since we had commented previously does not have to remain in place by more than 7 months, because that globe begin to be deflated and the resistance of the walls will be debilitated by the gastric acid and initiates the risk of migration and it can cause intestinal obstruction.

This is the case of a of 23 year-old lady, who had been implanted an intragastric balloon for weight lost, she did not show up for the appointment of the date of balloon removal, to the 10 months to be implanted, patient who complained of of severe abdominal colic pain and vomiting that are symptom typically of balloon migration to the bowels; the patient was hospitalized, the plain abdominal film showed that the balloon was deflated outside of the stomach, powerful laxatives the same that we used for the preparation of the colon for the colonoscopy (was given (Oral sodium phosphate solution), after 72 hours the balloon had not been expelled that give us the possibility that this balloon had been stopped in the ileocecal valve where these can cause intestinal obstruction by that we decided to make a special grasping uniting two with weld since these are not made for colonoscope. A colonoscopy was performed the balloon was found at the sigmoids where was easy to manipulate and extract it with a rat-tooth grasping (foreign body forceps).

We have had 4 cases of intragastric balloon migrations, the first case was after 11 months to have been placed the patient begun with symptoms, while in the hospital were carefully monitoring with abdominal ultrasound and abdominal radiography, oral sodium phosphate solution was administered, 48 hours after initiated with the symptoms the intragastric balloon was expelled by rectum.  

The second case was this presenting here, the third casealmost to the year to have been placed, she had not luck toexpelled by rectum because the balloon was retained in aloop of the Ileum due to the patient has multiple bowelpostsurgical adhesions formation this patient underwentan open laparotomy. The four case after the symptomsstated, the balloon was expelled spontaneously in the nextday.

 

 

Intragastric Balloon Migration

Intragastric Balloon Migration

Plain Abdominal Film belong of a patient that had the balloon in place for more than 11 months, this intragastric balloon is recommended have to be removed before the end of the 7 months.

Show that the balloon is deflated in the right iliac fossa

Most of the our cases of balloon migration have been expelled by rectum except one that was retained in a loop of the Ileum due to the patient had multiple bowel post surgical adhesions.

 

To see this image enlarged press here.

 

 

 

 

A close up of the Balloon Deflated and Migration

A close up of the Balloon Deflated and Migration

Migration through the bowels and expelled by rectum

 

To observe this image enlarged press here.

 

 

 

Intragastric Balloon for the treatment of Obesity.

Sequence 1 of 3.

Intragastric Balloon for the treatment of Obesity.

An intragastric balloon is observed which is deteriorated by gastric acid, the black valve is almost intact.

 

 

Intragastric Balloon

Sequence 2 of 3.

Intragastric Balloon for the treatment of Obesity.

The other side of the balloon, the white valve is observed, the balloon was tear and had left the double layer polyurethane, this globe had remained almost 9 months in the gastric camera, was found in the antrum almost to emigrate.

 

Intragastric Balloon for the treatment of Obesity.

Sequence 3 of 3.

Intragastric Balloon for the treatment of Obesity.

This balloon was deteriorated, quite soft and easy to manipulate. It was removal only with the foreign-body forceps (rat-tooth) instead of the special designed grasping.

 

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