Gastric Balloon Procedures
The gastric balloon is an innovative weight loss procedure that avoids surgical intervention, is temporary, customizable, and removable in cases of need. Unlike stapled procedures, gastric balloons do not alter the gastrointestinal system but instead use the power of taking up real estate in the stomach to reduce the amount of food the patient can eat and induce satiety.
Currently, there are two major types of gastric balloons. The first is liquid filled and goes by the brand name Orbera. The second is gas-filled and goes by the name of Obalon. In both cases, the gastric balloon is placed using an endoscopic procedure. This is where the not-yet-inflated balloon is passed through the esophagus and placed in the stomach using an endoscope. No surgical intervention is required. The gastric balloon is then filled with saline or gas and sized appropriately for the patient.
The gastric balloon remains in the stomach for approximately six months. During this time, it takes up additional space in the stomach, forcing the patient to eat less and generally feel fuller sooner. Patients will work with their physician on a comprehensive lifestyle management program that includes improved diet and exercise to enhance the procedure’s benefits during this time.
At six months, the balloon is removed. This is important because the highly acidic nature of the stomach will eventually break down the balloon’s skin and potentially cause harmful side effects. The removal of the balloon is very similar to its placement, and the procedure is again performed endoscopically.
The history of the gastric balloon
The FDA first approved gastric balloons in 2015. The original gastric balloons were the Orbera, a single balloon liquid-filled system, and the Reshape double balloon liquid-filled system. A year later, Obalon, a gas-filled balloon, was introduced as an alternative. Apollo Endosurgery, owners of the Orbera balloon, acquired the reshape balloon in late 2018 and subsequently retired its use in early 2019. The Orbera and Obalon gastric balloons continue to be offered in the United States. A third gastric balloon procedure known as the ellipse has been marketed in Europe and elsewhere in the world but has not yet been approved in the United States.
Risks of the gastric balloon
When used correctly and as indicated, the risks of the gastric balloon are relatively low, but some can be serious. Some of the risks and considerations include:
- Nausea and stomach pain in the first few days after placement. This is relatively normal, and your physician may prescribe anti-nausea medication to reduce the symptoms.
- Spontaneous balloon filling with additional air or liquid was noted in just over 2% of patients in the Orbera post-approval study. This seems to occur mainly with the liquid-filled balloons and specifically with the Orbera gastric balloon. For most, hyperinflation requires the removal of the balloon.
- Rarely, acute pancreatitis or inflammation/infection of the pancreas may occur in liquid-filled intragastric balloons. The root cause is still being investigated but could be due to the distention of the stomach putting pressure on the pancreas.
- Rarely deflation of the balloon can obstruct the bowel. Most commonly, however, the balloon passes through the bowel without issue.
- Gastric perforation is a very rare but serious risk of gastric balloon placement. The risk of gastric perforation is significantly increased if the patient does not return at the appropriate time to have the balloon deflated and removed.
Please be sure you understand the risks of a gastric balloon and the signs to look out for it by speaking to your surgeon or gastroenterologist. Any abnormal abdominal pain should be discussed with your healthcare team as soon as possible. If you believe you’re having an emergency, do not delay visiting the nearest emergency room or dialing 911.
Costs and Insurance
Notably, gastric balloons are typically not covered by insurance; therefore, patients will have to pay for the procedure out of pocket. Cost ranges from $6,000 – $10,000, depending on the practice and location. It is also important to remember that the procedure is temporary, and patients must maintain their new and improved diet and exercise program for the rest of their lives to ensure the procedure’s success.