Baris D Yildiz, MD. Ankara Numune Teaching Hospital
The most widely studied of the minimally invasive endoscopic therapies for obesity is the gastric balloon (GB).
Here we describe two cases of endoscopic balloon placement in which balloons did not inflate properly without causing any immediate or long term complications.
36 years old female patient applied to our out patient clinic for treatment of her obesity. Her body mass index was 41.1kg/m². Under sedation Heliosphere BAG® (Helioscopie,Vienne, France) was inserted orally into the stomach. The usual sequence of the procedure involves pulling the string holding two edges of the plastic envelope covering the balloon and inflating the balloon with 550cc of air. When this sequence is followed the balloon takes a uniform round shape. But in our case there was a part on the balloon which did not expand . Our efforts to inflate this portion using more air were unsuccessful so we ended the procedure. A postoperative plain upright abdominal x-ray showed irregular balloon sitting inside fundus (Figures available). The patient did not have any immediate postoperative problems and was discharged. She had lost only 7kg at that time thus her percent excess weight loss (%EWL) was 6.6% at six month post prodecure. When examined the appearance of deflated balloon was normal without any abnormal structural findings .
43 years old male patient presented to our obesity clinic. The same procedures as described for Case 1 were applied and again the balloon did not fully inflate (Figures available). Five and half months after balloon placement he was called in and the balloon was taken out. He had lost only 8kg at that time thus his %EWL was 5%.
Intragastric balloon was developed as a minimally invasive alternative to surgical treatment of obesity. The question whether it is worth wasting time and money on GB trying to induce weight loss in obese individuals is still debated . In our country, Heliosphere BAG® balloons cost arround $1000 per piece and state medical insurance only pays for one piece if the patient fully qualifies for the treatment. Thus if GB placement is unsuccessful patient does not have a chance for a second balloon. So for both cases we faced a dilemma of either extracting the balloon out our keeping it inside. Fortunately both patients did not face any complications.
Median weight loss of 15-17 kg and up to %32 EWL were reported for GB by different authors. Our patients had much lower weigth loss and %EWL when compared to these results. We are certain about the amount of air we filled the balloons with. So volume of balloons can not be a factor in this failed weight loss.
Structure of the intragastric balloon might influence %EWL and manufacturers must be vigilant about errors in production line and upgrade product technology for better outcomes.
It might not be cost effective using intragastric balloon for preparation for a definitive obesity surgery procedure in developing countries.