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Gastric balloons have been used extensively as an adjunct to diet and behavioral modification in the treatment of exogenous obesity. Small bowel obstruction occurred in a 42-year-old female after her balloon migrated through the pyloric channel. The authors describe a simple method for percutaneous deflation which permitted the balloon to pass through the gastrointestinal tract thus relieving the obstruction.
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A study was conducted to test the efficacy and safety of a 300 ml silicone-rubber gastric balloon for weight reduction. Eighty-six obese subjects were distributed into four groups: (1) gastric balloon only, (2) gastric balloon and prescribed 1000 kcal/day (239 kJ) diet, (3) 1000 kcal/day diet only, and (4) no treatment. The intervention period was 3 months. The balloon only group lost 3.2 kg +/- 0.9 (s.e.), the balloon and diet group lost 5.1 +/- 1.0 kg, the diet group lost 6.9 +/- 1.4 kg and the control group gained 0.6 +/- 0.5 kg. The three intervention groups each lost significantly more weight than the control group. The diet only group lost significantly more weight than the balloon only group. Body densitometry showed that the treatment groups lost a significant amount of body fat. Gastroscopy revealed three ulcers and two superficial erosions at balloon removal. The gastric balloons were well tolerated despite gastric spasms and nausea which abated after the initial 24-48 hours. Gastric capacity was determined in a subset of 19 subjects from the two balloon groups before the intervention by distending the stomach with a balloon and calculating the volume required to produce an increase in intragastric pressure of 5 cm H2O. Subjects with a smaller gastric capacity lost more weight with the balloon than subjects with a large capacity (r = 0.45, P less than 0.05). These results suggest that for improved efficacy, balloon volume may need to be larger than 300 ml or adjusted to the individual's gastric capacity.(ABSTRACT TRUNCATED AT 250 WORDS)
Complications during a pregnancy caused by a gastric balloon as a weight reduction device are presented. We refer about a patient in the 35th week of pregnancy who suffered with abdominal cramping. She was studied for hours before the decision for a laparotomy and cesarean section was made. Just before starting, a gastric balloon which was implanted in the early pregnancy for loss of body weight was expelled and the patient was healthy.
A gastric balloon was endoscopically implanted in seven over-weight (36-58%) patients to achieve weight reduction on an out-patient basis. During the period of observation four patients spontaneously passed the balloon transanally, one after brief intestinal obstruction with abdominal cramps and vomiting, another with the development of ileus, which responded to eight days of conservative treatment. The occurrence of such not insignificant side effects suggests that at present the use of endoscopic implantation of gastric balloons is not a reasonable way of treating obesity.
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BACKGROUND: In super, super obese patients (body mass index [BMI] >60), especially those with extreme intra-abdominal fat deposition, the technical difficulties in laparoscopic procedures increase. The purpose of this study was to evaluate whether gastric balloon therapy (GBT) can improve the operative conditions for laparoscopic adjustable gastric banding (LAGB) in extremely obese patients. MATERIALS AND METHODS: From April 1995 to August 1998, 196 LAGBs were performed. In 15 patients (7 female and 8 male), median age 38.8 years (range 17-54), who had been selected as suitable candidates for bariatric surgery, preoperative GBT was studied. Fourteen patients were extremely obese (BMI 60.2 kg/m2 [range 58-72]). One 17-year-old boy with BMI 46.6 kg/m2 was also treated. The Bioenterics Intragastric Balloon (BIB) was used. The placement, the volume modification, and the removal of the BIB were performed endoscopically. Close follow-up was possible in 14 patients. After balloon removal, 13 patients underwent LAGB. RESULTS: In 14 of 15 cases, GBT was successful. There was only one ballon dysfunction. The mean weight loss was 18.1 kg, and the median duration of balloon therapy was 16.8 weeks. After balloon removal, body weight started to increase. CONCLUSIONS: In our experience, the gastric balloon can improve the conditions for laparoscopic surgery in super and in super, super obese patients. There was no conversion to open surgery. The effect of weight loss is much less than immediately after LAGB. However, after failure of all conservative treatments to reduce the preoperative body weight, the GBT seems to be the last possibility.
A less invasive method than gastric reduction surgery for treating obesity was tested by inserting balloons into the stomachs of obese rats. Male Sprague-Dawley rats were placed on a high fat diet. After 4 months, the rats weighed an average of 750 g or 23% more than rats on a chow diet. Balloons were then passed orally into the stomach, inflated with 10 ml of water, and detached from the inflating tube. Eight rats had inflated balloons; six rats had no balloons. The balloons, which could be palpated, remained inflated for 12 to 49 days with a mean of 25 days. During the period of inflation, rats with balloons consumed significantly less food (p less than 0.001) relative to rats without balloons. Gastric emptying rate was significantly slowed (p less than 0.0025) in rats with inflated balloons compared to rats with balloons that had deflated and rats with no balloons. Histology of the stomachs that held inflated balloons did not reveal pathology.
BACKGROUND/AIMS: In obesity, many gastro-oesophageal reflux promoting factors are present. Weight reduction is advised to symptomatic overweight subjects. The aim of the present study was to investigate the influences of untreated obesity, weight loss, and chronic gastric balloon distension on the lower oesophageal sphincter (LOS) function. METHODS: Patients entering a randomized, double-blind, sham-controlled study of balloon treatment, consisting of 4 months of either sham balloon or balloon treatment followed by 4 months of balloon treatment. Manometry and 24-hour pH measurements were performed at the start of the study and after 13 and 26 weeks. RESULTS: Before treatment, LOS dysfunction was present in 7 of 32 patients (21.9%). Increased upright and supine reflux was present in 8 patients (25%). Sham treatment resulted in a weight loss of 9.7% with improved LOS function (a significant 0.6-cm increase in LOS length and a non-significant 2.6 mm Hg higher LOS pressure) and in a significantly decreased upright reflux (acid reflux time decreasing from 8.0 to 5.5% and number of meal-related and postprandial reflux episodes decreasing from 49 to 32). These improved values deteriorated after 4 months of balloon placement, with significantly increasing total, upright, and supine reflux to 7.5, 7.6, and 6.7% of the time, respectively, with oesophageal lesions after an overall 17.8% weight loss. Four months of balloon treatment induced a similar weight loss (9.9%) with significantly increased supine reflux from 1.6 to 6.7% of the time. After a second 4-month balloon period and an overall 13.8% weight loss, LOS and reflux values returned towards baseline values. A comparison of both groups demonstrated the adverse effects of balloon positioning after a period of substantial sham-induced weight loss. CONCLUSIONS: Impaired LOS function and increased gastro-oesophageal reflux were observed in one quarter of the untreated obese subjects. Weight loss ameliorated manometry and pH values, but subsequent balloon positioning tended to counteract these beneficial changes. In patients on balloon treatment from the start, adverse effects seemed to wear off with prolonged treatment.
BACKGROUND: Gastro-oesophageal reflux is an obesity-related health risk assumed to improve after weight loss. Prolonged intragastric balloon distension might oppose this. The purpose of the study was to investigate the prevalence of gastro-oesophageal reflux in untreated obese subjects and to study the consequences of weight loss with or without intragastric balloon treatment. METHODS: Patients participating in a randomized double-blind, sham-controlled trial received balloon or sham treatment for the first 13 weeks. Thereafter, all subjects received a balloon for the remaining year. Twenty-four-hour pH recordings were made at the start, after 13 weeks of balloon or sham treatment, after 26 and 52 weeks of balloon treatment and 13 weeks after balloon removal. RESULTS: Group-wise, pH data of 42 untreated patients (BMI 43.4 kg/m2) were highly abnormal. On an individual level, 22 subjects (52%) had some evidence of reflux, 17 patients (40%) showed pathological total reflux times and 8 (19%) had combined total, upright and supine reflux with grade B reflux oesophagitis in only one patient. Albeit poorly, oesophageal acid exposure was related to body weight and visceral fat distribution. A reduction in acid reflux was observed in sham-treated weight-losing subjects, whereas in balloon-treated subjects supine reflux and duration of the longest reflux increased. In the second 13-week period, the initially improved pH values worsened by balloon placement in sham-treated subjects. Values in balloon-balloon-treated subjects stabilized. After 52 weeks, acid reflux levelled off at pretreatment values and further improved after balloon removal. At these times, decreased visceral fat masses correlated significantly with diminished oesophageal exposure to acid. CONCLUSIONS: Obesity predisposed to gastro-oesophageal reflux. Body weight loss and, strikingly, visceral fat loss resulted in improved reflux parameters. Adverse effects on acid reflux by gastric balloon distension wore off over time.
Balloon tamponade of esophageal variceal hemorrhage is palliative therapy which is associated with a certain incidence of morbidity, perhaps mortality. Three cases of intrathoracic inflation of the gastric balloon of such tubes are described. The precise mechanism of thoracic placement remains uncertain. Fluoroscopy or chest x-ray should be used to confirm appropriate tube tip placement.
The use of inflatable intragastric balloons is a new non-intensive approach in the treatment of obesity when poor results are obtained by more conservative treatment. The intragastric balloons are certainly less hazardous than bariatric surgery but their long term effect on body-weight reduction it is not still proved. Several types of balloons are currently in use. The two used most widely are the Garren-Edwards Gastric Bubble and the Ballobes Balloon. The Authors report their experience with these two types of anti-obesity gastric-balloon in 60 grossly obese patients.
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To determine its efficacy and safety in treating obesity, a silicone-rubber balloon was passed into the stomach of 10 nondieting, obese subjects. In a counterbalanced sequence, the balloon was inflated with 400 mL for 1 mo and deflated for 1 mo. Lower intakes of solid and liquid test meals (NS), significantly slower gastric emptying, and concomitant changes in glucose, insulin, glucagon, and cholecystokinin concentrations consistent with slower emptying resulted during balloon inflation. After balloon inflation, one small gastric ulcer developed, which subsequently healed. Significant weight loss occurred during the second and third week of the inflation period (F[1,9] = 5.0, p less than 0.05). However, the weight loss was small and the significant effect did not continue through the fourth week.
The rapid sequence induction of anaesthesia in patients with an increased risk of pulmonary aspiration is a quite involved procedure associated with many potential dangers. A new nasogastric balloon tube has been developed, which will prevent the reflux of gastric contents by blocking the cardia with a balloon. It was the aim of this initial study to assess the efficiency of the tube in animals, healthy volunteers and patients. METHODS. With the approval of the Animal Ethics Committee, a total of 16 anaesthetised pigs were used for the animal experiments. Balloon occlusion of the cardia was performed in 10 pigs. Six further pigs with an unblocked cardia served as controls. Vomiting and regurgitation was provoked in each animal using six different manoeuvres while the gastro-oesophageal (lower oesophageal) sphincter and intragastric pressures were monitored and the lower oesophagus was continuously inspected using an endoscope. With local Ethics Committee approval and informed written consent, (1) repeated vomiting was provoked in 16 awake, healthy adult volunteers (10 females, 6 males, 29 +/- 4 years) with a fluid-filled stomach in the presence and in the absence of balloon occlusion of the cardia, while intragastric pressure was monitored, and (2) 30 patients (21-89 years) with an increased risk of pulmonary aspiration scheduled for abdominal or traumatologic surgery received conventional induction of anaesthesia after blocking of the cardia with the balloon. RESULTS. Pigs (n = 10) with a blocked cardia showed no gastro-oesophageal reflux during a total of 60 manipulations to provoke vomiting and regurgitation, while 28 of the 36 provoking manipulations induced reflux in pigs (n = 6) with an unblocked cardia. Among the healthy volunteers with a blocked cardia (n = 16), reflux of gastric contents was not observed during repeated attempts to stimulate vomiting. After termination of the occlusion of the cardia, reflux was able to be induced by 14 of the 16 volunteers. In 30 patients with an increased risk of pulmonary aspiration the cardia was blocked and anaesthesia was induced using a mask and manual ventilation without encountering any problems. The average time from loss of consciousness to tracheal intubation was 164 +/- 8 s. CONCLUSIONS. It is concluded from the present results, with further clinical studies pending, that the gastric balloon probe permits low-risk conventional induction sequence of anaesthesia in patients with an increased risk for pulmonary aspiration and that the device may also be safely used during the extubation phase.
An evaluation of the Garren-Edwards gastric bubble in the treatment of obesity was done. Several clinical trials have compared the effects of behavior therapy with and without the bubble, but the effects of the bubble alone have not been previously evaluated. Ten obese women averaging 91% overweight received the bubble without adjunctive therapy during a 12-week treatment period. Frequent psychological and laboratory measures as well as weight were obtained during the study to explore the possible mechanisms of the bubble's effect and its side effects. Mean weight change was -2.5 kg, with a range of -8.8 to +1.6 kg. Four patients lost more than 3.5 kg, three lost less than 3.5 kg, and three gained weight. The Garren-Edwards gastric bubble alone does not appear to provide significant benefit to most obese patients.
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