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11 August 2005 CUHK
Pioneers the Use of Intragastric Balloon for Obesity
Intragastric balloon is a newly developed non-surgical weight reduction treatment. The procedure involves the placement of a saline-filled silicon balloon inside the stomach for 4-6 months by endoscope to decrease the capacity and emptying of stomach, and therefore, consumption of food. Early satiety produced by the balloon facilitates compliance to a hypocaloric diet. Together with an increasing level of physical activity, results in dramatic weight loss. There are a lot of advantages of intragastric balloon. The procedure can be easily performed within thirty minutes on an out-patient basis and does not require general anaesthesia. More importantly, it can be repeated when indicated and is totally reversible. The reported weight loss in the literature can be up to 15-20% of the body weight. Most side effects such as nausea and vomiting are usually mild and will usually subside after two weeks of placement. A significantly higher acceptability of the intragastric balloon technique is observed in Chinese patients than other kinds of obesity surgery. Although intragastric balloon treatment is generally safe, strict compliance to doctors' recommendations and follow-up plans is required to avoid serious complications like premature rupture of balloon and stomach perforation which can be potentially dangerous. Suitability of intragastric balloon of each individual has to be carefully assessed by multidisciplinary obesity team with intragastric balloon experience before the treatment. The following conditions are considered not suitable for intragastric balloon: 1)
Previous gastric surgery CUHK has introduced this new technique at the Prince of Wales Hospital for management of obese Chinese patients since November 2004. To date, a total of 48 patients (34 women; mean age 39.4) have undergone intragastric balloon. The mean body weight (BW) and body mass index (BMI) were 105 (range: 67 to183.6) kg and 39 (range 26.5-69.1) kg/m2 respectively. The obesity team critically selected the most suitable patients before the application of intragastric balloon procedure by extensive investigations and counseling. Based on Western and our experience, potential Asian candidates suitable for intragastric balloon are as follows:
1) Patients with morbid obesity (BMI >50) as a pre-surgical treatment
to minimize surgical risks After balloon placement, patients need to adopt a new diet regimen. They are advised to take fluid diet in the first week and normal diet can then be gradually introduced. A hypocaloric diet of around ~1200 kcal/day and 150 minutes/week of moderately intense exercise are prescribed during the programme. The balloon needs to be taken out on or before 6 months to avoid premature leaking or rupture. All patients are followed up by the obesity team monthly at the combined obesity clinic of Prince of Wales Hospital to monitor progress. Our initial results are very encouraging. We observed a mean weight loss of 16.4 kg (14.9% of BW) and 42.6% of excessive body weight loss after six months in most cases. The mean waist circumference loss after the programme was 12.9cm. Most obesity-related diseases such as high blood pressure and high cholesterol were alleviated with significantly improvement in quality of life after the treatment. There were no serious complications and 85% of patients were extremely satisfied with the programme. The ultimate aim of the intragastric balloon programme is to correct the eating habits of our patients through behavioral modification. The patients learn to eat slowly with less food. With an increased level of physical exercise, obese patients should be able to live more healthily and less prone to obesity-related diseases. Our initial results showed that the intragastric balloon technique is safe and very effective in treating obesity in our population.
From the left : Dr. Wilfred Lik
Man MUI, Honorary Clinical Assistant Professor, Department of Surgery;
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