Bioenterics Intragastric Balloon (BIB)

What an intragastric balloon is?

The BIB is a temporary non-operative method helping to lose weight by partially filling the stomach, inducing the feeling of satiety and assisting in getting used to proper dietary habits. The balloon is placed in to the stomach by endoscope and filled with 500-700 cc of blue-coloured saline solution, causing it to expand into a spherical shape. The placement of BIB is limited to maximum 6 months, and then it has to be emptied and removed by endoscopy. The BIB has not been covered by the national health insurance.

How does the BIB work?

The balloon itself does not make the patient slim. It occupies the stomach and helps the patient to make the portions of meal smaller. The BIB system in the principle helps the patients to introduce healthy dietary and behavioural changes and to keep the required reduction diet. As the physiological response of the patient to the presence of the intragastric balloon is individual, the prediction of particular weight loss is only assumptive and usually achieves about 10 - 20 kg. The extent of weight reduction depends predominantly on coexisting supporting dietary, psychological and cognitive behavioural treatment, which should be built-in the BIB system. The patient is advised to follow his (her) urine and to come immediately for a check up when the urine turns blue, otherwise for a follow up control within the first week and in the month 2 and 4.

Introduction of the balloon

The endoscopic introduction of balloon in to the stomach is less burdening for the patient than an operation (e.g. laparoscopic gastric banding). It usually does require neither a general anaesthesia nor a hospitalisation. Initially an intravenous medication for sedation is given to the patient. Then an anaesthetic spray in to the mouth and throat helps to tolerate the introduction of the BIB well. The insertion of deflated BIB system by mouth through oesophagus to the stomach follows immediately after the diagnostic gastroscopy rules out any inflammatory or neoplastic lesion in the region. The procedure takes only about 20 - 30 minutes and the patients then stay for a short observation in the bed, checked by a doctor regularly. It is not recommended to drive a car the same day until 12 hours after the procedure because of used drugs. Patients usually experience severe nausea, vomiting and belching within the first 3- 5 days after the BIB introduction. Those symptoms vary in their intensity and usually disappear within few days. Antiemetics and PPI drugs (Gasec once a day) usually helps the tolerance of BIB. The removal of the balloon is performed in a similar way within 3 to 6 months. Dietary consultations are offered before the introduction and before the extraction of BIB.

Is BIB suitable for everybody?

Event though BIB is not an operation but an interventional endoscopic procedure requiring no general anaesthesia, indication criteria for BIB are similar to those in bariatric surgery.

Indications

• Pre-surgical temporary use in extremely obese patients (e.g. BMI above 50) to become ready for a bariatric operation, a life-long definite solution
• Patients with BMI 40 and above or 35 with co morbidities who are not fit for an operation
• Obese patients (BMI above 30) with significant health risks related to their obesity who have failed to achieve or maintain sufficient weight loss with a long-term supervised weight-loss program (diet, behaviour, excersize) designed to increase the possibility of long-term weight-loss maintenance.

Contraindications

• BMI below 30, weight-loss for cosmetic reasons only
• Patients who have had previous abdominal gastrointestinal surgery
• Inflammatory disease, lesions with potential upper gastrointestinal tract bleeding, large hiatal hernia
• Alcoholism or drug addiction, major prior or present psychological disorder
• Pregnancy or breast feeding
• Patients unwilling to participate in an established medically-supervised diet and behaviour modification treatment programme with routine medical follow up.

Complications

• Intolerance: continuing nausea, vomiting, gastric discomfort, feeling of heaviness.
• Leakage: The blue colour of the saline solution infused to the balloon would signalise any potential leak from the silicone BIB by turning the discharged urine to blue or green colour. A leakage and partial empting of the balloon may cause a small bowel obstruction requiring an urgent surgery. Therefore the patient should come immediately to a check up when the urine colour changes. Ultrasound and Xray examination can estimate the size and location of BIB. Early leak detection and removal of an impaired BIB may avoid any serious complications.
• Organ injury and perforation. During the insertion or removing of BIB an injury or even a perforation could happen. According to literary data few cases of spontaneous stomach disruptions did happen in patients who have had a previous abdominal operation, probably due to perigastric adhesions.

Instructions for international patients

We offer you introducing of the BIB system in Czech republic in case you are fulfilling the above mentioned indication criteria. If you wish to receive a personalized opinion of a bariatric surgeon, please fill the following questionnaire.