In obesity treatment, one of the most commonly performed and non-surgical applications is the gastric balloon. Its first clinical use dates back to the 1980s, making it a time-tested and widely used procedure. Over the years, improvements in design and technology have led to various types of gastric balloons on the market. Currently, there are three main methods for gastric balloon application. With this technique, patients struggling with obesity can lose up to 35 kg, and some may also use it preoperatively to reduce operative risks before weight loss (bariatric) surgery.
Below is a quick overview of how gastric balloons are categorized, focusing on:
- The substance used to fill the balloon (air vs. liquid)
- How long the balloon remains in the stomach (e.g., 6-month or 12-month balloons)
- Mode of application (e.g., endoscopic vs. swallowable)
1. By the Filling Material (Liquid vs. Air)
Two basic substances are used to inflate gastric balloons: liquid (serum) or air. For maximum effect and better results, liquid-filled balloons are more commonly recommended because the added weight and volume help you feel fuller faster and for longer. Air-filled balloons exist, but they are less frequently chosen.
2. By Duration of Stomach Placement (6 Months vs. 12 Months)
Gastric balloons placed endoscopically can differ based on how long they stay in the stomach:
- 6-Month Balloon: Stays in the stomach for 6 months, after which it must be removed endoscopically.
- 12-Month (Adjustable) Balloon: Stays in the stomach up to 12 months and may be adjustable (e.g., Spatz-3 balloon). Since it remains longer, it can potentially yield more durable results compared to 6-month balloons.
3. By Application Method
There are three main approaches to gastric balloon placement, each varying in technique:
- 6-Month Endoscopic Balloon
- Overview: A silicone balloon is inserted endoscopically under sedation (no incisions, no surgery).
- Procedure: Typically takes around 25 minutes. The balloon is introduced into the stomach in a deflated state. Once confirmed safe via endoscopy, it is inflated with 400–600 ml of blue-stained serum.
- Duration: The balloon remains in the stomach for 6 months, after which it must be removed endoscopically.
- Pros: Short procedure time, moderate cost.
- Cons: Fixed volume, cannot be adjusted if discomfort or lower weight loss is observed.
- Spatz-3 Adjustable 12-Month Balloon
- Overview: An endoscopically placed adjustable silicone balloon that can remain for up to 1 year.
- Procedure: Similar insertion process under sedation. Initial fill typically 450–500 ml.
- Key Advantage: Adjustable Volume: If weight loss stalls after a few months, additional fluid (e.g., +200 ml) can be added endoscopically to increase the balloon volume and enhance satiety. Conversely, if the balloon feels too uncomfortable, fluid can be reduced.
- Result: Provides a dynamic 12-month approach, often yielding higher weight loss success rates than 6-month balloons.
- Balloon Removal: Performed endoscopically at the 12-month mark.
- Swallowable (Elipse) Balloon
- Overview: No endoscopy or anesthesia required. The patient swallows a capsule containing the balloon, connected to a thin catheter.
- Procedure: After the balloon is verified via X-ray or similar imaging, it is inflated with special fluid (~550 ml). Then the catheter is gently removed through the mouth.
- Duration: Balloon remains in place for approximately 16 weeks (4 months). After this period, a self-release valve allows the balloon to deflate and exit naturally via the gastrointestinal tract.
- Pros: No endoscopy, no anesthesia, convenient.
- Cons: Shorter duration (only 4 months). If more weight loss is desired, another balloon might be placed.
Which Balloon Type to Choose?
Each of the above methods offers distinct benefits and drawbacks depending on the patient’s needs and comfort level:
- 6-Month Endoscopic Balloon:
- Ideal for those seeking a fixed 6-month weight-loss boost.
- Typically simpler and shorter-term.
- Less flexibility if the balloon feels too large/too small.
- Spatz-3 Adjustable 12-Month Balloon:
- Best for maximum weight loss potential over a longer, 1-year period.
- Volume can be adjusted mid-treatment to improve comfort or effectiveness.
- Often suitable for patients aiming for significant weight loss or needing a dynamic approach.
- Swallowable Balloon (Elipse):
- No anesthesia or endoscopy required.
- Remains for 4 months.
- Great option if minimal intervention is a priority and moderate weight loss is acceptable.
Adapting to the Balloon: Key Considerations
All balloon types can cause mild to moderate gastric discomfort — especially in the first 3–4 days (nausea, cramps, bloating). Adjusting diet (light or liquid-based) can alleviate these symptoms. The Spatz-3 adjustable balloon can lower fluid volume if discomfort is excessive, unlike fixed-volume options. Over-the-counter or prescribed anti-emetics and antispasmodics help control nausea or cramps.
Which Balloon for Optimal Results?
- For maximum weight loss and a longer program (up to 12 months), the adjustable Spatz-3 is very effective.
- For minimal procedure and no endoscopy/anesthesia, the Elipse swallowable balloon is ideal, though it stays only 4 months.
- For standard 6-month intervention, the fixed 6-month endoscopic balloon is a tried-and-true approach.
Ultimately, success depends on choosing the most suitable option and following recommended dietary changes and exercise routines. With proper adherence, patients may lose between 10% and **15% of their initial body weight. Patients can also opt to repeat balloon placement or move on to more definitive obesity surgery if desired.
Conclusion
When deciding which gastric balloon is right for you, consider:
- Desired Duration (4, 6, or 12 months)
- Anesthesia/Endoscopy requirement preference
- Potential Adjustability of balloon volume
- Weight-Loss Goals and Lifestyle Factors
A careful consultation with a bariatric specialist or gastroenterologist is essential to tailor the balloon choice to your individual health status, weight-loss target, and lifestyle.
