Intragastric Balloon Application (Endoscopic Video)

BioEnterics Intragastric Balloon

Heliosphere Intragastric Balloon

Intragastric Balloon Application Sedation Anesthesia

Intragastric balloon application is an effective treatment option which has gained popularity in recent years. The patient must be comfortable and compatible for this operation can be executed. Generally there is high anxiety (excited and nervous) level at these patients since they are in a nervous mental state because of thinking and worrying about how will conclude the operation and whether they will feel the attempt during the operation or not. A kind of sleep state that we have called “sedation” is an ideal anesthesia method for this attempt. The quality of sedation anesthesia during that short lasting attempt simplifies the attempt as well as enables it to complete without awareness of the patient. Necessary care is shown to provide the patient has a hunger level for 6 hours pre operation.

An anesthesiologist evaluates the patient before the sedation application. He learns his/her diseases have been experienced and the habits. Anxiety of the patient is important and defining it is guiding the drug doses will be administered.

Vascular access of the patient is opened before the operation. A catheter is placed in the one of veins at the hand or arm. All of the drugs and serums are given through this way later.

Whole operation is executed at the operation room with the secure conditions. After the patient has lied on the stretcher, a relaxant is given from intra venal and the patient began to be followed. The patient is admitted to operation room after enough relaxation (additional drug is given if there isn’t any change for desired level). Additional drugs are given to patient at operation room to provide more sound sleep. The attempt is begin after the providing enoygh sleep level. The patient is in the deep sleep now and he/she doesn’t hear and feel anything almost. When asked to them, the patients have stated that they didn’t remember anything after, our experience of over 450 cases performed by A/P Dr. Halil COSKUN in our application center. Most of them have indicated that they didn’t believe at the first period that the ballooon has been inserted. The mean duration for all of this implementation is 20 – 25 minutes.

The patient is admitted to the rest room in the operation room after the attempt. He/she is kept waiting here and observed and sent to the room when the vigilance level reach to desired level. The patient keeps sleeping if he/she spent the night sleepless and tired, but responses if spoken. Our patients are discharged with suggestions after keeping under observation for 4-6 hours at hospital.

Intragastric balloon removal operation is executed in the same way by implementing of sedation anesthesia. Our patients are discharged after keeping under observation for 2 hours after the removal of the balloon.

Sedation anesthesia is a very ideal and secure method. But it should not be forgotten that this ways to provide sleeping should not be applied without anesthesiologist and full equipped operation room. Because the immediate distribution of sedative drugs differs as to the fat mass index could be high at the obese persons. It should be took care to comply with the rules for providing the highest level safety of the patient.

Assoc. Prof. Halil Coskun

Intragastric Balloon (Technical Specifications, Types and Comparisons)

There are 3 types of patented intragastric balloon in the world for today (September 2009). Two of them are fluid injection intragastric balloon (Bioenterics® ve Silimed®) and one is air injection intragastric balloon (Heliosphere®). The processing mechanisms of each three products are technically similar.Following you can look over to technical comparisons of three products.

Editor’s Comment 1

Although the intragastric balloons have technically similar features, Heliosphere®, has encountered with some problems related with design at the patent stage and it’s implementations are going on in the some centers in Europe and in our country for the present. The key problems related with the product are those the scientific data on Heliosphere® is insufficient and the multicentric results still haven’t been published. In addition it isn’t possible to be noticed by the operator in the event of puncture at the balloon because of Heliosphere® is inflatied with air.
Bioenterics® intragastric balloon is the most implemented product in the wolrd and in Turkey and it’s scientific results have been declared. Particularly in Italy at Europe and in Brasil at South America multicentric study results have been published and it’s efficiency level has been proved.
Similar results have been seen when you look at the weigh loss outcomes. The scientific study results for Heliosphere® those will be published in the coming years will be more useful to show the differences and the similarities between two products.

Editor’s Comment 2 : (October 2009)

In addition to the previously used 2 intragastric balloons, fluid injection Silimed® Intragastric Balloon which has been included to the field of application with the completion of the patent stage in 2008 has been also began to be used. This intragastric balloon is quite similar to Bioenterics® Intragastric Balloon. It is a very important characteristic to be injected with fluid and it is seen at the same value with Bioenterics® in confidence.
Heliosphere Intragastric Balloon has realized a change in design structure in 2008 again and the case structure on the balloon has been changed to prevent the air leakage. Furthermore the capacity of this gastric balloon has been also lowered from 900 cc to 600 cc like the other fluid injection balloons.
Gastric balloon applications are continued to be used as common practice all over the wolrld. Altough they are used to prepare particularly the obese patients with very high weigh (BMI>50kg/m2) to the surgery treatment, they are also suggested to be used as an auxiliary and supporting treatment method to provide weigh loss at the overweight patients those have (BMI 27 – 35 kg/m2) at the beginning of the obesity but couldn’t lost weigh with diet or other treatment methods.

Assoc. Prof. Halil COŞKUN M.D.
www.halilcoskun.com
halilcoskun@hotmail.com

Intragastric Balloon Aplication

Gastric Balloon is an application which has been increasingly gained popularity in recent years. The most important advantage of this method is to be performed endoscopically without general anaesthesia requirement.

Internal volume of the stomach is durable to be inflated with fluid or air between 400-700 cc. Restriction of the stomach volume is provided due to this additional volume and so over food intake is constrained because of the stomach volume has been decreased.

Approximate duration of the implementation is 15-20 min. Hospitalization is not necessary and the patients are discharged after 5-6 hours monitoring and intravenous serum application.

Nausea, vomiting and pains like cramp can be observed post application, particularly at first 48 hours. Medical treatment is applied to remove such diseases. Those complaints are temporary and the patient will considerable relief after around 1 week.

Gastric Balloon Application is a non-surgical teraphy. It is an adequate choice specially for the patients which don’t consider the surgical teraphy but can not loss weight enough. However this application is limited in terms of duration, the balloon’s staying length at stomach is 180 days (6 months) maximum. It has to be removed after that period. Removing process is also carried out endoscopically and the patients return to their normal activation after 2 hours.

The patients can loss 30 – 90 % of their excess weights in the meantime. Achievement at the weight loss is closely associated with the patient collaboration. Calorie limitation is suggested to the patients after application. (1000-1200 Kcal). This limitation is performed easily because of the over food intake constraint due to application.

If the gastric balloon is considered to stay at the stomach more than 180 days then it must be necessarily replaced with the new one. The patients which consider that application have to change their eating habits in a 6 months period.

The complications associated to the gastric balloon application are rare. Balloon intolerance and rarely puncturing of the balloon have been declared at literature. It is necessary to removing the balloon endoscopically in such a case.

Consequently; Gastric Balloon is an easily applicable method which can be suggested to the obese patients those don’t consider surgical terapy or avoid from such surgical processes (gastric banding – staple or gastric bypass). However the patients have show effort to change their eating habits to provide lasting weight loss in a long term along with this method.

Assoc. Prof. Halil Coskun MD

halilcoskun@hotmail.com