(By Sarah Boseley) Although not a replacement for bariatric surgery, temporary balloon could be used as early intervention or for those who do not want, or cannot have, surgery.
A balloon that can be swallowed and then filled with water while in the stomach can help obese people to lose large amounts of weight without invasive surgery, a new study has shown.
Bariatric surgery to reduce the size of the stomach is highly effective, but anaesthesia for somebody who is very overweight can be risky. Those who want to undergo the surgery must also undergo a long period of preparation to ready them physically and psychologically. It is expensive, and there is a long waiting list in the UK, even though NHS guidance recommends it be considered.
The balloon is swallowed like a pill, and has a long thin tube attached. Once in place in the stomach, the balloon is filled with water through the tube, which is then detached and pulled back up the throat. Photograph: Zack Williamson/WilliamsonVisual
The balloon is swallowed like a pill, but with a long thin tube attached. Ultrasound is used to determine when the balloon is in place in the stomach, and it is then filled with water through the tube. The tube then detaches and is pulled back up the throat and out.
Unlike gastric surgery, the balloon is a temporary measure. After 16 weeks, it bursts in the stomach, the water is released and the balloon itself is excreted.
A small study presented at the European Congress on Obesity in Porto, Portugal, showed that the 38 patients enrolled in the trial had lost a mean 15.2kg (33.5 lbs) by the end of the 16 weeks, which amounted to about a third (mean 31%) of their excess weight.
At the end of the 16 weeks, the patients were encouraged to eat a Mediterranean diet to try to maintain their weight loss.
Obesity experts say the balloon could be useful in the NHS – which has no approved weight loss drugs as yet – but point out that it is not a substitute for bariatric surgery, which can deliver lifelong change.
“The technology in and of itself is interesting but you have really got to deal with people’s eating behaviour before you intervene,” said Professor Jason Halford of the European Association for the Study of Obesity.
Anybody who has any sort of gastric balloon or sleeve which restricts the size of the stomach has to change their eating habits. There are some foods they cannot eat easily, such as chewy meat. Only small amounts can be eaten at a sitting, and those who have a sweet tooth may be tempted to eat only sweet things.
Before bariatric surgery, potential patients have to undergo what is known as “Tier 3”, which involves psychological counselling and nutritional education. “It is a very permanent change in your life,” said Halford.
The swallowable gastric balloon, however, might have a role at an earlier stage or for those who do not want, or are not suitable for, surgery. “People are looking for alternatives,” he said.
“I think this is for people before they would get to the point where they need bariatric surgery. Potentially millions could benefit … but these have got to get through clinical commissioning groups (CCGs) and they do not have a lot of money.”
The wider use of bariatric surgery was recommended by the National Institute for Health and Care Excellence (Nice) in 2014. In the previous year, there had been 6,500 operations, but Nice said two million more people could be eligible for surgery. The procedures could save the NHS millions because they can reverse type 2 diabetes, which is very expensive to treat in the long term; Nice found that happened in 65% of cases.
Dr Roberta Ienca from the Sapienza University of Rome in Italy, who presented the study, said: “Because the Elipse Balloon does not require endoscopy, surgery or anaesthesia, this may make it suitable for a larger population of obese patients not responding to diet/lifestyle treatment and also for use by a variety of clinicians — nutritionists, dietitians, and internists — who currently do not have access to or are qualified to fit endoscopic or surgical weight loss devices.”
Dr Simon Cork, research fellow at the department of investigative medicine at Imperial College London, said it was an interesting study and that the balloons may be useful for those who need to lose weight urgently, for instance ahead of an operation. But, he said, “sadly, the weight lost through this balloon will undoubtedly be put back on soon after the balloon is removed.”