Introduction

Obesity is a complex metabolic illness which increases the prevalence of diabetes mellitus,hypertension, coronary heart disease, sleep apnea, stroke, gastroesophageal reflux disease, gallbladder disease, certain types of malignancy, and non-alcoholic fatty liver disease. Current therapeutic approaches to obesity are lifestyle changes, pharmacologic treatment, and bariatric surgery.Intensive lifestyle modification was reportedly associated with only limited weight reduction.Weight reducing drugs are associated with issues of safety and high costs. Although Weight-loss surgery provide most sustained and effective therapeutic choice for obesity ,it is associated with  risk leading to increasing mortality and morbidity. Endoscopic bariatric therapy (intragastric balloon) provides greater efficacy with lower risks than do conventional surgical procedures.

How does intragastric balloon work ? 

1. It  allow patients to sense fullness and ultimately reduce their food intake.

2. It facilitates satiety peripherally by being and obstacle to food consumption, decreasing intragastric volume, and delaying gastric emptying.

3. It affects hunger control and gastric emptying by altering gut hormones and peptides such as ghrelin, leptin, cholecystokinin,and pancreatic polypeptide

Indication of Intragastric balloon

1. BMI > 35 kg/m2,

2. BMI > 30 kg/m2 with certain commodities

Exclusion criterias 

1. Large Hiatus hernia (> 5 cm)-

2. Active ulcer in the stomach or duodenum

3. Previous surgical resection of the stomach

4. Inflammatory bowel disease

5. Gastrointestinal neoplasm

6. Oropharyngeal abnormalities

7. Active gastrointestinal bleeding

8. Coagulative disorder

9. Variceal disease

10. Alcohol or drug abuse

11.Psychiatric disease

12. Pregnancy

13. Use of anticoagulants or anti-inflammatory drugs

14. Cardiovascular, pulmonary or cerebrovascular diseases comorbidities

How balloon is placed ?

It is a simple nonsurgical, noninvasive, incision less outpatient procedure. Under mild sedation first  diagnostic endoscopy is done to look for any contraindications. The deflated gastric balloon is inserted through the esophagus and into your stomach. A syringe is then used to fill the balloon with a sterile saline solution. The entire procedure takes about 20 to 30 min. After the procedure the patient is kept 2 hr for observation.Then the patient is discharged with proper dietary advice. 

What is the efficacy ?

If the patient follow the strict dietary advice,he/she will lose around 15 to 25 kg within 6 to 9 months.

How Balloon is removed?

After 6 months the balloon is removed endoscopically. 

What are the adverse effects ?

1.Gastric discomfort,nausea and vomiting can occur during first week after procedure

2.Bleeding, perforation are the very rare complication 

3.Esophagitis, Gastric ulcer and GERD may occur. 

Conclusion

Intragastric balloon is a  a minimally invasive and effective method for managing obesity. It shows promise in improving the quality of life and health status for obese patients. It provide greater efficacy with minimal side effect than bariatric surgery.