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The Weekend Neos Kosmos : 1 November 2014
SATURDAY 1 NOVEMBER 2014 19 FEATURE A balloon that will 'deflate' you Dr George Marinos guides us through a safe, non-surgical procedure which guarantees maximum weight loss NELLY SKOUFATOGLOU There has been a lot of talk about the Spatz balloon lately. Is this intragastric balloon an effective weapon against non- morbid obesity? Is this the long-awaited solution for those hesitant to go under the scalpel? Dr George Marinos specialises in gastroenterology and hepatology and is an adjunct senior lecturer at the Faculty of Medicine, University of New South Wales. "The intragastric balloon is an effective and extremely safe non-surgical procedure available for weight loss. A soft, expandable, silicone balloon is placed inside the stomach via a camera that enters through the mouth. Once inserted into the stomach, the empty balloon is filled with sterile saline, occupying a large part of the stomach, creating a feeling of fullness," Dr Marinos tells Neos Kosmos. This minimally invasive procedure is done in a day surgery under light sedation. Discharge occurs within two hours of the procedure. "The procedure is completely reversible. It works by reducing hunger, enforcing portion control thus achieving target weight loss of 10-30 kg. An allied health team works with the patient to maximise outcomes and to facilitate weight maintenance after removal." What differentiates the new Spatz intragastric balloon, though, from other intragastric balloons? According to Dr Marinos, it is the only intragastric balloon that is approved for one year implantation and is adjustable. "It can be inserted at very small volumes, thus it is much better tolerated than fixed volume balloons which are inserted at much larger volumes, maximising weight loss and preventing rebounding. "This is why Spatz patients lose 17-24 kg as opposed to 12-15 kg for standard six month non-adjustable balloons. If any untoward symptoms - such as nausea, vomiting or pain - persist, the balloon volume can be diminished by 100-200 mls which alleviates symptoms allowing patients to continue with the device without the need to prematurely extract it - as is the case with fixed volume intragastric balloons." To qualify for a Spatz balloon there are certain prerequisites a patient has to meet. The patient should have tried and failed diets in the past; must be fit enough to be able to undergo an endoscopy; must be able to comply to a follow-up schedule with dietician and medical doctors; and must be overweight with a BMI (body mass index) greater than 27. Dr Marinos says the complication rate is similar to other intragastric balloons, with an overall risk of less than 0.1 per cent. "Risks include balloon deflation and peptic ulceration. All patients are required to take anti-ulcer medication to prevent these complications. In over 1,500 balloons that we have managed we have had no serious adverse event. "Its maximum duration is 12 months, but it can be removed earlier at any time if the patient reaches their goal weight. In cases where the patient wishes to extend treatment and lose more weight, we can re-insert a new balloon for another 12 months." Maintenance studies have reported that 64- 76 per cent of Spatz balloon patients are able to maintain medically significant weight loss even two years after device extraction, favourably compared to the 25 per cent rate of the six month standard intragastric balloons post-extraction. Playing devil's advocate, one cannot help but wonder what happens if a patient's appetite does not decrease. Some people think this saline-filled balloon is all it takes to fight the flab. Does it extinguish the munchies for extra food on its own or do workouts and healthy eating need to be incorporated into the routine? "The balloon volume can be increased to a maximum 1,050 mls. This can facilitate a further 8-9 kg weight loss, while the fixed balloon's maximum volume is 700 mls," says Dr Marinos. "It is not a magical cure. It requires follow-up with the treating centre, a change in dietary habits and behaviour. Keeping an intragastric balloon in for one year and adjusting the balloon volume gives patients a chance to succeed and a longer period of time to change their behaviour," he tells Neos Kosmos. As for affecting one's daily regime, during the first week of the procedure, as expected, it is not recommended to plan any heavy activities. Once the body has adjusted to the balloon, no problem should occur. In fact, starting a regular exercise program is highly advisable. One can even drink alcohol in moderation - in accordance with Australian dietary guidelines. The whole procedure - including evaluation, tests, insertion and follow ups - costs over $5,000. The total out-of pocket cost for the entire program is $5,250 for patients with private medical insurance. This cost covers all aspects of the patient's care including insertion and removal of the Spatz intragastric balloon, all adjustments of the Spatz intragastric balloon, all medical and dietician follow-ups and all after care for six months after the Spatz intragastric balloon is removed. Prevention is by far the best cure. A healthy diet combined with vigorous activity might make you 'huff and puff', but it will also help to maintain a normal weight from an early age. When weight gain is related to medical reasons and gets out of hand, the Spatz balloon seems like an option offering long- term benefits without taking the risk of going under the knife. For more information visit www. gastricballoonaustralia.com.au Dr George Marinos The Spatz intragastric balloon. Gastric band versus gastric balloon.
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