Gastric Balloon Vs. Gastric Surgery

Question Below Submitted By:  

Antoinette (a patient from Denver, Co)

I’m wondering if I should be considering gastric surgery (sleeve, lapband, or bypass), or should i get the gastric balloon? I cycle between 40-70 pounds overweight and I am 5’10. What do I need to take into consideration when deciding if the balloon is right, or should I go the surgery route? I’d prefer NOT to get surgery, but I’m willing to if the balloons can’t control my weight. Thanks a lot, Antoinette
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Expert Responses to the Question Above

Surgeon Response To: GASTRIC BALLOON VS. GASTRIC SURGERY

by: John M. Rabkin, M.D.

Antoinette,

The Inflatable Intra-Gastric Balloons (IGB) of which there are three different FDA approved devices currently available with another two nearing FDA approval, are a relatively new category of weight loss device options in the United States. Previous IGB designs used in the mid 1980's failed due to complications and were withdrawn from the market after an approximately six month period of availability in the US after initial FDA approval. Following that experience, IGBs were abandoned for use in the US.

Revised IGB devices made a resurgence in Europe over the last two decades. With the more recent favorable European experience, a reexamination of the utility of IGBs led to a subsequent successful filing in the US with the FDA for their approval/use in this country. However, since their release in the US, there have been several reported deaths in patients after having IGBs placed which prompted the FDA to recently issue a 'Black Box' warning (so called due to the warning statement being surrounded by a black border or box on the device packaging and associated printed materials) although the deaths have not definitively been shown to be device related.

IGBs have been demonstrated to assist with modest weight loss in the patients who undergo the procedure. However, the results are transient as the balloon has to be removed at six months after placement. Many patients face weight regain unless another balloon is placed at that time. Consequently, for durable weight loss, surgery is the better option for you to consider.

In order to qualify for weight loss surgery, however, you must be 'morbidly obese:' In other words, your BMI (height to weight ratio) must be 40 or greater or at least 35 if you also suffer from one or more of the major obesity related medical morbidities such as diabetes mellitus, high blood pressure or obstructive sleep apnea. If you cycle between 40 to 70 pounds overweight at 5'10" and don't have one of those conditions, you may not meet the qualifications for weight loss surgery. Requirements to have an IGB placed are less stringent although obtaining insurance coverage for the IGB may be daunting.

John M. Rabkin, M.D.
Pacific Laparoscopy

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