How do you shrink your stomach without surgery? For many obese individuals, the answer may be an Intragastric Balloon. Doctors use an endoscope to insert a deflated balloon in your stomach and fill the balloon with a sterile saline solution. The inflated balloon is left in place for about six months while you lose weight, learn new ways to eat and turn your health around.
Tune into SMG Radio and listen to Summit Medical Group Gastroenterologist Dr. Hazar Michael explain the medical pros and cons of the Intragastric Balloon.
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Intragastric Ballon For Weight Loss - A Non-Surgical Procedure That Might Be Right For You
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Learn more about Hazar Michael, MD
Hazar Michael, MD
Dr. Hazar Michael is a gastroenterologist with more than 20 years of experience in the field. In addition to being a member of SMG, she is a Clinical Associate Professor of Medicine in the Division of Gastroenterology at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School in New Brunswick.Learn more about Hazar Michael, MD
Transcription:
Intragastric Ballon For Weight Loss - A Non-Surgical Procedure That Might Be Right For You
Melanie Cole (Host): If you're suffering from obesity and diet and exercise haven't worked for you, you might want to consider an intragastric balloon for weight loss. My guest today is Dr. Hazar Michael. She's a gastroenterologist with Summit Medical Group. Welcome to the show, Dr. Michael. People have heard about bariatric surgery but not everybody is either a candidate or has the desire to go through all of the different needs for bariatric surgery. What is the intragastric balloon?
Dr. Hazar Michael (Guest): The intragastric balloon is a balloon we place endoscopically. So, it's a simple procedure, an upper endoscopy to be done, then we deploy the balloon. The balloon is made from silicone. The balloon currently is FDA-approved for stage 1 and stage 2 obesity, which is BMI between 30-40, for health, as aid to lose weight.
Melanie: So, are there certain people who might not be candidates? As we know with bariatric surgery, there's a whole psychological profile that goes on and counselling and you have to fit in the certain parameters. What about the intragastric balloon?
Dr. Michael: Absolutely. It should be some patients who not good to be candidate. The balloon is not good to be candidate for anybody with any major psychiatric disorder or eating disorder, mainly because patient safety. The balloon should be an aid to get healthier and we need to be sure the patients are able to follow up instruction and take care of themselves. And, as a condition that would preclude the placement of the balloon any prior gastric or esophageal surgery, including prior bariatric surgery and lab band placement; anybody with severe inflammation of their esophagus, ulcer or unusual tendency for bleeding. Also, anybody who's not motivated to diet and exercise and use the balloon as a weight loss and not willing to change their lifestyle or their eating habits. They're not going to be candidates for the balloon placement.
Melanie: Tell us about the procedure itself. This is a non-invasive procedure, yes?
Dr. Michael: It's minimally invasive because it's an endoscopy. So, what happens is patient will come to our ambulatory surgical center. They will undergo conscious sedation by our certified anaesthesia team and after that, we perform an upper endoscopy to be sure there is nothing in the endoscopy that will make the balloon placement unsafe. And after that, if everything looks okay, we'll place the balloon in the stomach and monitor it deployed under endoscopic guidance. After the procedure, patient will be discharged home in the next hour or two, depending on how they feel, and typically the patient needs to be closely monitored. They need to use medication to manage their symptoms after the procedure placement. The balloon, FDA-approved for six months, mainly to be sure the integrity of the balloon, and at six months, patient will come back, will undergo another endoscopy and the balloon will be removed.
Melanie: When you insert the gastric balloon, is it inflated or do you insert it and then inflate it?
Dr.Michael: We'll insert it non-inflated, then will inflate it with about 600cc of saline to inflate the balloon.
Melanie: Does the patient feel this balloon in their stomach?
Dr. Michael: They will feel the balloon, especially the first few weeks, because suddenly you have your stomach is full and this how patient will lose weight by giving them sensation of satiety. The first week after the balloon insertion, the symptom could be hard, but usually we are very careful. We'll be contacting our patients daily to monitor them and we'll be giving them instruction about medications to help in aiding this symptom. By second week, and definitely by the third week, the majority of the patients will go back to their baseline and will be able to eat but we encourage sensible eating portions so they will achieve their weight loss goal successfully.
Melanie: So, what is eating like for the patient in that first week or so following the procedure?
Dr. Michael: Usually, the first week, it's mainly clear liquid diet, then full liquid diet, then like very thin like a cream of wheat. By second week, usually they'll be able to eat soft food. By the third week, a majority of the patients will be able to progress to kind of small portions of solid food which we recommend frequent small meals when the balloon is placed to help them to lose the weight. Will be very similar kind of the bariatric surgery diet.
Melanie: So, Dr. Michael, as you are a gastroenterologist, do you see that this balloon increases reflux? What happens if somebody suffers from reflux and they want this balloon?
Dr. Michael: Yes, it will increase your chance for reflux. But, before we started, before we place the balloon, we start patient on strong anti-reflux medication called PPI and the patient needs to remain on this class of medication for the entire duration of the balloon placement to minimize reflux and/or to prevent from development of ulcer in the stomach. Having severe reflux or severe inflammation of the esophagus when we do the endoscopy will make it contraindicated to place the balloon.
Melanie: And then, when they can eat, normally, what do you tell them about lifestyle modifications, exercise, and what types of foods that you would like them to concentrate on and are there any foods, Dr. Michael, that are off-limits at that point?
Dr. Michael: I think that the only stuff will be off-limit during the balloon placement is carbonated beverage because the carbonation in the beverage may interfere with the balloon integrity. Also, we recommended preferably non-caffeinated beverage or lightly caffeinated beverage. As far as the food, really the recommendation is one to be healthy sensible portion, and variety of food. We recommend high protein, low in fat and avoid large quantity of any sugary food or drink, which really the majority of us should be doing anyway to help us to achieve healthier lifestyle. And portion control is very important.
Melanie: And, what is the removal like?
Dr. Michael: The removal is another endoscopy. Patient don't feel anything. For safety purpose, we may need to protect their airway by placement endotracheal tube just for the removal part for safety. Otherwise, it's really not that big deal. The removal takes an average of about half an hour.
Melanie: And then, afterwards is there any lasting effect from this balloon? Is there any scar tissue that might have developed? Or, has their appetite changed sufficiently that now this is just been a tool to aid in future weight loss?
Dr. Michael: There is no scarring of the balloon. The balloon surface is very small. It does not cause any damage to the lining of the stomach. As far as their appetite, I think the way I look at it, the balloon is like your six months of rehab. I think the majority of us learn to overeat and stretch our stomach. The balloon will teach us a new way of feeling full and, hopefully, if somebody doesn't overeat and go back to old habits, they will be able to maintain the weight loss. The balloon by itself is not a magic bullet and it's not going to be the magic solution. It’s something that is going to hype you to control your appetite once the balloon is in, so you could practice again and again on modification of lifestyle, including both exercise and eating habit. If you're not willing to exercise and change the way you eat, then I think the balloon or any bariatric surgery should not be done because you're really not achieving anything. It's a way to enable you to actively engage in changing your lifestyle.
Melanie: What types of results have you seen with this minimally invasive procedure different than somebody who does a non-reversible bariatric surgery?
Dr. Michael: The balloon is not going to be as effective as a standard bariatric surgery for sure and the balloon right now only approved with BMI of 30-40. So, bariatric surgery for somebody with morbid obesity is definitely better. The result is the balloon is about 40% loss of excess body weight. For example, if you are, maybe like 40 lbs. overweight, on average, the majority of patients will lose about 16-20 lbs and about 10% of total body weight loss. I think if patient is really more engaged and more active, in my opinion, they'll probably be able to lose more and continue the weight loss after the balloon’s removal.
Melanie: Absolutely fascinating, Dr. Michael, and give your best advice, please, for people that are considering the intragastric balloon system procedure for weight loss. What you tell them every single day about this procedure and why they should come to Summit Medical Group for their care.
Dr. Michael: I think I will tell the patient if you're really stage 1 and stage 2 obesity, you try very hard with diet and exercise alone to lose weight, you're not successful and you don't have any major comorbidity, probably the balloon is good way because it does not really alter the anatomy and overall it’s safer than surgery. And, I think it really should be considered to be an aid to weight loss and six months period to allow us to rehab and practice better eating habits and lifestyle. Why we should come to Summit Medical Group? Here the gastroenterology team at Summit Medical Group including myself, we have extensive expertise with all aspects of endoscopy and I have a large experience dealing with various conditions associated with bariatric surgery. We have very nice infrastructure setup. We'll be working closely with our bariatric surgeon, with our dietician and our facility setup is a state-of-the-art facility. We get lots of support from the nursing staff and from our management and, really, I was very impressed how quickly and swiftly everything we need to implement the balloon safely has been carried out by our staff and leadership.
Melanie: Thank you so much, Dr. Michael, for being with us today. You're listening to SMG Radio. And for more information, you can go to www.summitmedicalgroup.com. That's www.summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.
Intragastric Ballon For Weight Loss - A Non-Surgical Procedure That Might Be Right For You
Melanie Cole (Host): If you're suffering from obesity and diet and exercise haven't worked for you, you might want to consider an intragastric balloon for weight loss. My guest today is Dr. Hazar Michael. She's a gastroenterologist with Summit Medical Group. Welcome to the show, Dr. Michael. People have heard about bariatric surgery but not everybody is either a candidate or has the desire to go through all of the different needs for bariatric surgery. What is the intragastric balloon?
Dr. Hazar Michael (Guest): The intragastric balloon is a balloon we place endoscopically. So, it's a simple procedure, an upper endoscopy to be done, then we deploy the balloon. The balloon is made from silicone. The balloon currently is FDA-approved for stage 1 and stage 2 obesity, which is BMI between 30-40, for health, as aid to lose weight.
Melanie: So, are there certain people who might not be candidates? As we know with bariatric surgery, there's a whole psychological profile that goes on and counselling and you have to fit in the certain parameters. What about the intragastric balloon?
Dr. Michael: Absolutely. It should be some patients who not good to be candidate. The balloon is not good to be candidate for anybody with any major psychiatric disorder or eating disorder, mainly because patient safety. The balloon should be an aid to get healthier and we need to be sure the patients are able to follow up instruction and take care of themselves. And, as a condition that would preclude the placement of the balloon any prior gastric or esophageal surgery, including prior bariatric surgery and lab band placement; anybody with severe inflammation of their esophagus, ulcer or unusual tendency for bleeding. Also, anybody who's not motivated to diet and exercise and use the balloon as a weight loss and not willing to change their lifestyle or their eating habits. They're not going to be candidates for the balloon placement.
Melanie: Tell us about the procedure itself. This is a non-invasive procedure, yes?
Dr. Michael: It's minimally invasive because it's an endoscopy. So, what happens is patient will come to our ambulatory surgical center. They will undergo conscious sedation by our certified anaesthesia team and after that, we perform an upper endoscopy to be sure there is nothing in the endoscopy that will make the balloon placement unsafe. And after that, if everything looks okay, we'll place the balloon in the stomach and monitor it deployed under endoscopic guidance. After the procedure, patient will be discharged home in the next hour or two, depending on how they feel, and typically the patient needs to be closely monitored. They need to use medication to manage their symptoms after the procedure placement. The balloon, FDA-approved for six months, mainly to be sure the integrity of the balloon, and at six months, patient will come back, will undergo another endoscopy and the balloon will be removed.
Melanie: When you insert the gastric balloon, is it inflated or do you insert it and then inflate it?
Dr.Michael: We'll insert it non-inflated, then will inflate it with about 600cc of saline to inflate the balloon.
Melanie: Does the patient feel this balloon in their stomach?
Dr. Michael: They will feel the balloon, especially the first few weeks, because suddenly you have your stomach is full and this how patient will lose weight by giving them sensation of satiety. The first week after the balloon insertion, the symptom could be hard, but usually we are very careful. We'll be contacting our patients daily to monitor them and we'll be giving them instruction about medications to help in aiding this symptom. By second week, and definitely by the third week, the majority of the patients will go back to their baseline and will be able to eat but we encourage sensible eating portions so they will achieve their weight loss goal successfully.
Melanie: So, what is eating like for the patient in that first week or so following the procedure?
Dr. Michael: Usually, the first week, it's mainly clear liquid diet, then full liquid diet, then like very thin like a cream of wheat. By second week, usually they'll be able to eat soft food. By the third week, a majority of the patients will be able to progress to kind of small portions of solid food which we recommend frequent small meals when the balloon is placed to help them to lose the weight. Will be very similar kind of the bariatric surgery diet.
Melanie: So, Dr. Michael, as you are a gastroenterologist, do you see that this balloon increases reflux? What happens if somebody suffers from reflux and they want this balloon?
Dr. Michael: Yes, it will increase your chance for reflux. But, before we started, before we place the balloon, we start patient on strong anti-reflux medication called PPI and the patient needs to remain on this class of medication for the entire duration of the balloon placement to minimize reflux and/or to prevent from development of ulcer in the stomach. Having severe reflux or severe inflammation of the esophagus when we do the endoscopy will make it contraindicated to place the balloon.
Melanie: And then, when they can eat, normally, what do you tell them about lifestyle modifications, exercise, and what types of foods that you would like them to concentrate on and are there any foods, Dr. Michael, that are off-limits at that point?
Dr. Michael: I think that the only stuff will be off-limit during the balloon placement is carbonated beverage because the carbonation in the beverage may interfere with the balloon integrity. Also, we recommended preferably non-caffeinated beverage or lightly caffeinated beverage. As far as the food, really the recommendation is one to be healthy sensible portion, and variety of food. We recommend high protein, low in fat and avoid large quantity of any sugary food or drink, which really the majority of us should be doing anyway to help us to achieve healthier lifestyle. And portion control is very important.
Melanie: And, what is the removal like?
Dr. Michael: The removal is another endoscopy. Patient don't feel anything. For safety purpose, we may need to protect their airway by placement endotracheal tube just for the removal part for safety. Otherwise, it's really not that big deal. The removal takes an average of about half an hour.
Melanie: And then, afterwards is there any lasting effect from this balloon? Is there any scar tissue that might have developed? Or, has their appetite changed sufficiently that now this is just been a tool to aid in future weight loss?
Dr. Michael: There is no scarring of the balloon. The balloon surface is very small. It does not cause any damage to the lining of the stomach. As far as their appetite, I think the way I look at it, the balloon is like your six months of rehab. I think the majority of us learn to overeat and stretch our stomach. The balloon will teach us a new way of feeling full and, hopefully, if somebody doesn't overeat and go back to old habits, they will be able to maintain the weight loss. The balloon by itself is not a magic bullet and it's not going to be the magic solution. It’s something that is going to hype you to control your appetite once the balloon is in, so you could practice again and again on modification of lifestyle, including both exercise and eating habit. If you're not willing to exercise and change the way you eat, then I think the balloon or any bariatric surgery should not be done because you're really not achieving anything. It's a way to enable you to actively engage in changing your lifestyle.
Melanie: What types of results have you seen with this minimally invasive procedure different than somebody who does a non-reversible bariatric surgery?
Dr. Michael: The balloon is not going to be as effective as a standard bariatric surgery for sure and the balloon right now only approved with BMI of 30-40. So, bariatric surgery for somebody with morbid obesity is definitely better. The result is the balloon is about 40% loss of excess body weight. For example, if you are, maybe like 40 lbs. overweight, on average, the majority of patients will lose about 16-20 lbs and about 10% of total body weight loss. I think if patient is really more engaged and more active, in my opinion, they'll probably be able to lose more and continue the weight loss after the balloon’s removal.
Melanie: Absolutely fascinating, Dr. Michael, and give your best advice, please, for people that are considering the intragastric balloon system procedure for weight loss. What you tell them every single day about this procedure and why they should come to Summit Medical Group for their care.
Dr. Michael: I think I will tell the patient if you're really stage 1 and stage 2 obesity, you try very hard with diet and exercise alone to lose weight, you're not successful and you don't have any major comorbidity, probably the balloon is good way because it does not really alter the anatomy and overall it’s safer than surgery. And, I think it really should be considered to be an aid to weight loss and six months period to allow us to rehab and practice better eating habits and lifestyle. Why we should come to Summit Medical Group? Here the gastroenterology team at Summit Medical Group including myself, we have extensive expertise with all aspects of endoscopy and I have a large experience dealing with various conditions associated with bariatric surgery. We have very nice infrastructure setup. We'll be working closely with our bariatric surgeon, with our dietician and our facility setup is a state-of-the-art facility. We get lots of support from the nursing staff and from our management and, really, I was very impressed how quickly and swiftly everything we need to implement the balloon safely has been carried out by our staff and leadership.
Melanie: Thank you so much, Dr. Michael, for being with us today. You're listening to SMG Radio. And for more information, you can go to www.summitmedicalgroup.com. That's www.summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.