Gastric Balloon Centre

This is a Regenesis Books publication
First published in 2006

Regenesis Books Ltd is a specialised imprint dedicated solely to issues relating to weight loss and obesity

Regenesis Books Ltd is a subsidiary of
The Gastric Balloon Centre Ltd
Framingham Road, Sale, Cheshire, UK

Visit our web site at: www.stomachballoons.co.uk

Copyright © 2006 The Gastric Balloon Centre Ltd

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher.

A copy of the CIP data for this book is available from the British Library.

The National Gastric Balloon Centre Guide to

The Intragastric Balloon

Dr Phillip Thomas FRCS

Director
National Gastric Balloon Centre, UK

"Dr Phill" from the major BBC television series "Fat Nation"

Associate Member of the British Obesity Surgery Society
Member of the International Society for Lipolysistherapy
Council Member of the International Society for Alternative Uses of Gonadotrophin
Member of NETWORK-Lipolysis
Member of NETWORK - Weightdoctors
Advisor to the BBC on obesity
Formerly:-
Tutor in Surgical Gastroenterology, University of Manchester, UK
British Digestive Foundation Research Fellow
Visiting Professor of Surgery, University of Bologna, Italy

 

Regenesis Books

 

Contents

 

Contents

An Extremely Important Caveat

Books in the Regenesis NGBC Series

Introduction

The NGBC Mantra

Are you overweight?

What are the implications of being overweight?

Obesity as a chronic incurable lifelong disease

Why are we trying to lose weight?

Is there a secret to successful longterm weight loss?

What can you do about it?

What is the Gastric Balloon?

Am I a candidate for the Gastric Balloon?

Clinical experience with the BIB System

How effective is the Gastric Balloon?

The Gastric Balloon follow-up programme

What is the pattern of weight loss with the Gastric Balloon?

Your initial consultation

Timing of your Gastric Balloon placement

Preparing for your Gastric Balloon

The Day of insertion of your Gastric Balloon

How is the Gastric Balloon inserted?

The first few days with your Gastric Balloon

You've got through the first week

The next six months with your Gastric Balloon

Preparing for removal of your Gastric Balloon

The day of removal

What happens next?

The NGBC Club™

Complications of the Gastric Balloon

What does your NGBC fee cover?

About the Author

 

An Extremely Important Caveat

The material contained within this book refers only to the services and care provided by the National Gastric Balloon Centre. It must not be considered to represent the services and / or care provided by any other person or organisation using the stomach balloon for the management of obesity.

Many organisations offering the stomach balloon in the UK simply have salespeople booking the procedures, and then transport groups of patients en mass often hundreds of miles down to London. Here the balloons are inserted with little or no extra consultation, and the patients are then transported the long distance back home. Many then receive little or no advice or support during those very important first few days.

"They treated us like cattle. They had got our money and that was all that mattered to them", is a statement we hear often.

We know this to be true because these patients then come to us for that advice and support. They are often suffering many wholly avoidable symptoms, and are understandably very concerned, if not downright frightened.

This is a million miles away from the service provided by the National Gastric Balloon Centre.

The National Gastric Balloon Centre is one of the UK’s leading providers of the intragastric balloon system, and the only dedicated gastric balloon service in the country. Indeed, our Director has had a stomach balloon himself. We pride ourselves on our level of information and patient care.

We have more than 10 years experience in the management, both medical and surgical, of overweight and obese patients and we are pleased to be able to incorporate all of this experience and knowledge in the successful management of patients seeking the intragastric balloon. We are justly proud that patients from as far away as the United States regularly contact us.

This book, along with the others in the series, is merely an amalgamation of all our unique expertise and experience, and how we put that into practice with our stomach balloon patients.

Books In The Regenesis NGBC Series

Part of the secret of the success of the National Gastric Balloon Centre Programme is our attention the detail. We utilise a unique system to help our patients get the very most from their gastric balloon, both whilst it is in-situ and just as importantly, after its removal.

To do this, we have produced a series of publications to run alongside the programme itself. Each book has a very specific role within the whole process, and together they form what we believe top be the ultimate toolbox for any individual with a gastric balloon. Indeed, they would be a very significant help to anybody suffering with a weight problem of whatever magnitude.

The NGBC Guide to the Intragastric Balloon
A4, 75 pages approx, 12 illustrations
This book is the World's first definitive patient guide to increasingly popular stomach balloon for weight loss. In simple terms, it outlines the whole process of having a gastric balloon from start to finish.

The Regenesis Diet and Weight Management System
A4, 180 pages approx, 10 illustrations
The Regenesis programme is a simple proven three phase system to help you to a healthy longterm relationship with food. Devised by the author, this is the only book available detailing the methods involved. In clear simple language, it will help anyone with a weight problem to a healthier, happier, longer life. It is the system used very successfully by the National Gastric Balloon Centre with their stomach balloon patients.

The Regenesis Foodbook
A4, 100 pages approx, 20 illustrations
Written at the request of the author's own patients, this is much more than a recipe book. Using sound Regenesis principles, it is a full account of each and every aspect of food management for patients with weight problems. It helps the reader to a healthier eating pattern, with the minimum of fuss and effort. Its common sense, often humorous approach has been heartily welcomed by its readers. Again, it is used by the National Gastric Balloon Centre with great success.

The Regenesis Yearbook
A4, 100 pages approx, 10 illustrations
The key to lifelong successful weight loss and weight control is to be dedicated to the cause. Produced at the request of our patients, this annual publication makes it simple to keep to your new chosen healthier path. Packed with advice and tips, along with masses of material for you to complete, it is the ultimate aid for reformed yo-yo dieters!

 

In short,

The Key to Successful Weight Loss
and Long Term Weight Control

 

Introduction

The World Health Organisation reports that more then 1 billion people worldwide are overweight and at least 300 million are obese. An estimated 115 million of these people will develop serious medical conditions, including diabetes, heart disease, stroke, cancer and hypertension. Studies show that these potentially life-threatening conditions can be improved with weight loss.

Effective weight management for individuals who are overweight or obese is now possible. An internationally established programme can help you take control of your weight and your life - without the risks of surgery or drugs.

The BioEnterics® Intragastric Balloon (BIB®) Programme at the National Gastric Balloon Centre can help you transform your body and lifestyle in a safe and effective manner, improving your health, and enhancing your life.

 

 

 

 

 

 

 

 

 

The NGBC Mantra

Read it every day and heed it well -
it might just change or even save your life…..

Obesity is most definitely not your fault at all - you never really had a chance. Your government and their ties to big business; your environment; your genes; and those bad habits you have been made to adopt over a lifetime have all seen to that. Fight back!

So, please don't punish yourself for something that really has been done to you. Fight back!

After all, Obesity is a chronic debilitating metabolic disease with lots of horrible life spoiling and life shortening complications. Don't give in to it. Fight back!

Because Obesity really is totally TREATABLE - but you will have to help yourself too. Fight back!

And if you do, you WILL feel better and live longer, because almost all of the complications of Obesity are REVERSIBLE. But only if you fight back now!

Because, as yet, Obesity is not CURABLE. So you have to ….

Fight Back!

But we all need help to fight back, and a reliable WEAPON to help us.

Your first weapon is ….

The Intragastric Balloon

And your second weapon, just as vital, is ….

The National Gastric Balloon Centre's
Expert Care and Exceptional Services

So, first things first -

Are you overweight?
And, if so, by how much?

In short, how do you measure up?

This may seem a very simple question, but the answer is not as simple as you might think. Throughout this book, you will note that we place little relevance on so-called ideal weight. After years of treating significantly overweight people, it has become obvious to us that it is the patient themselves who eventually know when they have reached their own ideal weight. This is the weight at which they feel good about themselves; and have reversed any weight-associated health problems. The weight at which they feel the healthiest they have felt for years; with considerably more energy and verve. The weight at which they are able to look in the mirror and feel generally OK about themselves. This weight might not match any published ideal weight table, but so what. If it is right for them as an individual then that is great.

However, and this is still important, the medical profession has developed a measurement of weight that has implications for your potential health risks for any particular degree of overweight. This measurement is called your Body Mass Index, or BMI. Since it has become the internationally accepted measurement of weight and its implications we must discuss it briefly here.

Firstly, the BMI is an assessment of your body weight against the surface area of your body; this being deemed a more valuable correlation than your weight against your height alone. There is a BMI calculator in your NGBC Toolbox. In addition, BMI calculators can easily be found on the Internet.

So, armed with your BMI, you are now able to find out what it means for you. The World Health Organisation and others have stipulated the following as degrees of overweight:-

BMI under 18.5
Underweight
BMI 18.5 to 24.9
Normal Healthy Weight
BMI 25 to 25.9
Overweight
BMI 30 to 34.9
Moderately Obese
BMI 35 to 39.9
Severely Obese
BMI 40 to 49.9
Morbidly Obese
BMI 50 to 59.9
Super Obese
BMI over 60
Super Super Obese

 

So, which group do you fall into? If you have a BMI of 30 or more, then the Gastric Balloon may be the ideal solution for you.

You now know if you are overweight, and roughly by what degree.
So, what are the implications for you, if any?

In this section, we shall briefly discuss what terms like overweight and obesity mean, and why they are important medical conditions that you should take extremely seriously. This is why it was important for you to understand a little about what your BMI is and how you work it out. Now, I want you to understand just a little of why your own BMI is important for you. In a nutshell, its importance can be very simply put as follows.

* If you study whole populations of people looking at how their health is affected by their weight (BMI) you find that with increasing weight or BMI, humans are more likely to suffer from lots of medical; psychological; and social problems;
* As their BMI moves from 25 to 30, and through 30 to 40 and above, their RELATIVE RISK of these conditions also increases dramatically. Being overweight (BMI of 25 to 30) IS statistically worse for you than being of a normal weight. Being obese (BMI of 30 to 40) IS statistically more risky than being just overweight. And being morbidly obese (BMI over 40) IS statistically more dangerous for your health than being merely obese or overweight. And the risk becomes much more significant with every subsequent increase in your BMI over 40.

 

 

So, what are these medical and other problems that are associated with increasing weight? Let's start at the top and work our way down:-

 

Brain and Nervous System
Strokes
Depression
Anxiety and other psychological problems
Low self-esteem and self-loathing

Heart and Blood Vessels
High Blood Pressure
Angina
Heart attack
Heart failure

Lungs and Breathing
Asthma
Chest infections
Respiratory failure
Sleep apnoea

Intestines and associated organs
Acid heartburn
Gallstones
Fatty liver
Cirrhosis
Pancreatic disease
Insulin resistance and
Syndrome X

Kidneys and Urinary
Renal failure
Stress incontinence

Blood, Hormones and Immunity
Type 2 Diabetes
Raised cholesterol
Raised triglycerides
Lowered HDL fats

Sex and Fertility
Polycystic Ovary Syndrome
Irregular periods
Infertility
Gonadal diseases
Uterine bleeding
Difficult pregnancy with more complications; including gestational diabetes; hypertension; pre-eclampsia; early labour

Bones and Joints
Arthritis
Gout

Cancers
Breast (after the menopause)
Colon
Prostate
Ovarian

General Health
Lowered resistance to infections; even the common cold
Troublesome sweating
Breathlessness after very minimal exertion or even at rest
Poor sleeping patterns

Being Immobile, if not Wheelchair-Bound or even Bed-Ridden
Skin problems and bed sores
Uncomfortable joints
Increased risk of deep vein thrombosis and pulmonary embolus
Constipation
Urinary infections
EARLY DEATH

Social
Relationship problems; often insurmountable
Isolation
Inability to work
Inability to wash / look after yourself
Social harassment and victimisation
Reliance on the state for benefits and support

 

This list is not exhaustive, but gives you an extremely good idea of the range of problems potentially faced by the overweight and obese.

I have been quoted in the media many times as saying that, if we do not combat the plague of obesity as soon as possible, then during the course of the next generation, we will have millions (yes millions) of our population dying needlessly and prematurely after having suffered many years of chronic disability and debilitation.

Obesity very often means an unhappy, often pain and illness-ridden life, and an early death.

And that's a fact.

But, does this also mean that you cannot be mathematically obese and healthy at the same time? No it doesn't. There are many athletes, such as weight lifters and boxers who are most definitely mathematically obese, but who are incredibly fit. Does it mean that you are inevitably unhappy and shunned by society if you are obese? No, of course it doesn't. Many obese people are wholly fulfilled successful members of our society.

The whole point of these statistics that relate weight to medical and other problems is that, on average and comparing you with other non-obese subjects from your own population, if you are overweight or obese you are more likely to suffer from these associated conditions. Often much more likely, in fact. It doesn't mean that you will inevitably get these things; just that you are more likely to get them overall. Does that make sense? I hope so.

Further, and very importantly, if you lose even a relatively modest 10% of your body weight, you do a huge amount to reverse your own potential risk. Often, you will reverse your risk completely.

So, don't get scared. Get the weight off!!

 

I want you to consider your own obesity to be a chronic lifelong incurable disease

This might sound a bit scary, but read on.

If you are an asthmatic, you can usually be perfectly well controlled with appropriate medication (eg inhalers). If you are lucky, you may never suffer with any wheeziness at all. You may never have any symptoms of your asthma from one year to the next. But you are still an asthmatic.

The very same principle applies to diabetes and many other medical conditions that can be managed but not cured.

Similarly, after years of alcohol abuse and dependence, you may have been off the booze for many years. But you are still an alcoholic, as witnessed by the approach of Alcoholics Anonymous. "My name is Jack or Jane, and I'm an alcoholic".

In many ways, having a weight problem is much the same. I often say to patients "my name is Phill, and I have obesity". Even if my weight is well controlled, I've still got to keep my lifelong disease under control. I am in remission, but I am not cured.

This concept of obesity as a chronic disease helps us to explain to our patients why lifelong supervision of some kind is necessary to treat their condition adequately. This is why the overwhelming majority of our patients sign up for life long membership, with regular follow-up at least four times a year. Just like would happen with any other incurable but controllable medical condition. Being obese is not your fault, but you can do much to help yourself. After all, you'd be insane to smoke if you were an asthmatic, wouldn't you? So why do we all have such poor eating habits when we know we have a tendency to obesity? Crazy, isn't it? But we all do it. Mostly, it's just lack of thought and discipline. Maybe even laziness. Oh yes - and our toxic food environment and our oafs.

 

Why are we all doing this? What are we trying to achieve through all this misery?!!

Let's face it, "dieting" is miserable! Nobody should be on a dictated "diet" long term, unless they have a particular medical condition that necessitates it. Unfortunately, society; the media; retailers etc place so many emotional and other pressures on us to conform to their perceived "norm" that it is almost impossible to resist.

But resist you must!!

Several popular "diet" books promise to make or help you to get thin. This is ridiculous and flies in the face of both common sense and medical fact. In fact, the use of the word "thin" merely serves to compound the problem. There are basically two reasons to reduce your weight:-

* because being overweight predisposes you to many common medical conditions; chronic debilitation; and an early death (the medical reason)
* because being overweight generally makes you look older, and most people feel it makes them less attractive - if only to themselves (the aesthetic reason)

Consequently, almost all our patients fit into one or both of these categories. They want to lose weight because:-

* they know that, with only a fairly modest weight reduction, they will feel healthier; reduce or completely eliminate their risks of those common diseases; and hopefully live longer - which mostly they will
* they believe they will look better; feel better about themselves; be more confident; and look years younger - which mostly they do

Consequently, we don't set unrealistic target weights for our patients. We advise them as to the amounts of weight loss that would be beneficial medically, and say that if they want to go further for "aesthetic" reasons then that is great, but it is entirely a decision for them. If they do, then we are there to help them. But we always advise them if we think they are going too far. Most do want to go the extra mile, and benefit considerably from it. Reassuringly, almost all know when they have gone far enough. And, surprisingly, this may not be all that close at all to their "ideal weight".

 

Is there a secret to successful
long term weight control?

If you're anything like the vast majority of my new patients, they have been fighting their weight for years and years. In a sense, they come to a doctor almost as a last resort. To a man and a woman, they have all but stopped believing that anybody has ever lost weight successfully and kept it off in the long run. So, what do you believe? Do you think that anybody has ever succeeded where you think you have failed?

The answer is a resounding "YES"! Many have, and many do. So, what's their secret? How did they manage it when you don't seem able to?

The answer is actually remarkably simple. Scientists have looked at those individuals who have been successful at keeping their weight off, and they mostly seem to demonstrate most if not all of the following characteristics:-

 

 

* They purposefully adopt a positive mental attitude that their weight is wholly within their control, rather than something "done at them" so to speak;
* Most of them therefore adopt the attitude that it is solely for them, rather than somebody else or a group, to take responsibility for controlling their own weight;
* They therefore either do the whole thing by themselves, or seek the one to one guidance and help of a health professional or even a family member or friend if appropriate. But however they do it, they have taken control.
* In doing this, they purposefully set themselves short realistic goals, and don't punish themselves if they don't succeed this week / month etc;
* This is precisely because they see their weight management task as being a lifelong process, and most definitely not a quick fix;
* Consequently from the outset, they try to arrange and plan their lives to include a realistic amount of realistic exercise, which they then increase as their fitness increases;
* For them, it is much more to do with their health and self-worth, rather than how they look. They are treating, improving and nurturing their own self-esteem. For many, they are finally taking hold of themselves, and at last releasing the real person they used to be.
* Having addressed these issues, they must also address their eating habits.
* With regard to their food, they deliberately eat healthier foods;
* They deliberately eat smaller portioned but regular meals;
* They use low fat cooking techniques;
* And they incorporate a few healthy snacks throughout the day;
* They "allow" themselves to eat absolutely anything they like. They soon don't want most of the more "forbidden" types of foods anyway;
* They wholeheartedly recognise and accept that their unhealthy relationship with food must be faced and dealt with, often by making themselves deal with other issues in their life "head on" rather than diving into the nearest biscuit tin;
* And they religiously keep a food, weight and activity diary, even long after they have achieved their desired weight. Indeed, many continue to record these things forever. This has been found to be especially useful in maintaining long term weight loss and I recommend it absolutely. Indeed, that is precisely why we have produced the Regenesis Annual for our own patients. It makes keeping off all those hard earned shed pounds so much easier, and so much more pleasurable.

 

 

So, be honest.

How do you think you compare with this group?

Are you one of them already?

Can you make yourself become one of them?

Can you change from being an unhappy yo-yo dieter to a happy successful weight controller?

With the help of the

National Gastric Balloon Centre
and the
Regenesis Annual

you can.

AND YOU WILL!

What Can You do About It?

Nowadays, there is a wide range of options for those individuals suffering from varying degrees of overweight and obesity. The following overview is not exhaustive, but tries to highlight the relative pros and cons of each. Essentially, in order for a weight loss programme to be "perfect" it must:-

* Address why this particular patient is overweight;
* Determine why he or she has not succeeded with other diets;
* Assess their current relationship with food;
* Differentiate between the processes of immediate weight loss and long term weight management, and tackle each separately but concurrently;
* Address the issue of hunger during the programme;
* Include a defined behaviour modification programme;
* Include a defined food modification programme;
* Include a defined eating modification programme (we believe food and eating to be different elements);
* Include a defined activity programme;
* Include a defined support programme for long term weight management;
* Aim to have a patient at a healthy weight; with a healthy normal relationship with food; taking a healthy balanced normal diet; and taking some form of regular activity.

As you think about all the diets and weight loss programmes you have tried in the past, give some thought as to whether any of them paid any consideration to the elements above. We often tell our patients - "you didn't fail on the diets; the diets failed you!"

The decision of which option you choose is of course a personal one. However, some of the more severe options may be dictated rather more by the severity of your weight problems. Your options might include any of the following. Indeed, you may well have tried some or all of them already.

* Diets
* Group Diets
* Weight-Loss Medications
* Liquid Diets or Special Food Diets
* Medically Supervised Ultra-Low Calorie Diets
* Bariatric Surgery

And now …..

* THE GASTRIC BALLOON

In comparison to all the others listed, the gastric balloon programme at the National Gastric Balloon Centre addresses all of the elements necessary for successful long term weight control that I outlined above.

 

 

We utilise the Intragastric Balloon because this provides us with an exceptionally useful tool to:-

* help our patients both loss very significant amounts of weight quickly, safely and effectively;
* discuss the issues of hunger, whilst at the same time controlling their satiety;
* And importantly, use the six months that the balloon is in place to teach them a proven highly successful way to adopt a new healthy lifestyle.

We do this through our own Regenesis Diet and Weight Management System. This is exclusive to the National Gastric Balloon Centre and is the cornerstone to making our patients get the very most from their balloon, and is what makes our own programme unique. In simple terms, Regenesis is composed of the following elements:-

* The Regenesis Behaviour Programme to assess your current relationship with food; your previous dietary history; and a number of motivational tools to help you change your relationship with food and eating patterns;
* The Regenesis Food and Eating Programme that provides you with all the tools necessary to both make sensible food choices and then eat appropriately and healthily;
* The Regenesis Activity Programme to provide advice on how to adopt even a small amount of useful activity into your new lifestyle.

In addition, at the National Gastric Balloon Centre we also add the following:-

* The NGBC Support Programme to provide regular lifelong monitoring and support once the balloon is removed.

The fundamentally important point here is that, at the National Gastric Balloon Centre, we individualise each patient's programme to make it work most efficiently and effectively for them. We appreciate and acknowledge that each and every one of our patients is different. They have different strengths and weaknesses. They have different medical; social; or relationship problems. They have different life; work; eating; and activity habits. They have different motivations and fears. They have different levels of support or even antagonism to what they are trying to do. They have different goals.

In fact, they are all just different! We understand this. In fact, we believe that by recognising these differences, we are able to channel those very same differences to make the balloon programme work even better.

 

What is the Gastric Balloon?

Put simply, the gastric balloon is a soft silicone balloon.

When deflated it is attached to a soft fine tube or catheter, and is passed through your mouth, down your gullet and into your stomach.

Once in your stomach, the balloon is filled with sterile saline through the attached tube. When this is done, the tube is pulled back out through your mouth.

The balloon remains in your stomach for six months, after which time it is removed. This is simply done by again passing a tube through your mouth into your stomach, and puncturing the balloon so that the saline can be aspirated. The balloon is then simply pulled back out through your mouth.

 

The BioEnterics® Intragastric Balloon (BIB®) System and Program represents a safe, effective non-surgical, non-pharmaceutical alternative for the treatment of obesity. The BIB® System is designed to induce weight loss in obese patients by partially filling the stomach to help them firstly get less hungry, and secondly to feel fuller quicker.

 

Importantly, and very attractively for our patients, the Gastric Balloon does not require any surgery, nor does it rely upon potentially very dangerous drugs to achieve weight loss. It is simply placed via an endoscope with just a little sedation. Patients are discharged home in just a couple of hours, and most need little, if any time off work.

 

The BIB is a
* soft silicone balloon
* that is seamless
* but very strong
* It's durable, high quality silicone shell ensures resistance to stomach acid for up to six months.
* Consecutive balloons may be placed if indicated
* The balloon can be filled with volumes ranging from 400 ml to 700 ml during initial placement to individualize patient treatment
* It is filled with sterile saline to which a blue dye is added
* The dye changes the patient's urine to a blue colour should be balloon deflate spontaneously
* The balloon also has a radiopaque valve cap for X-Ray visualisation should this be necessary.

 

Am I a Candidate for a Gastric Balloon?

Earlier, we briefly discussed whether you yourself are overweight, and if so, by how much. Clearly, this is the logical starting point for any discussion as to the appropriate form of treatment or management of weight problems. We often get patients presenting for a balloon who have an entirely normal weight. These patients may (if not almost always) have other problems or issues to address, and a balloon is most certainly not for them.

To qualify for a gastric balloon, you should firstly be classified as at least obese. This means that, using the BMI scale, you should have a BMI of 30 or more (see the chart below). It is likely that balloons will soon be available to patients with BMI's of 25 to 30, who are struggling to lose weight; especially if they are a so-called "yo-yo dieter" or have weight-associated medical complications. Such yo-yoing is known to be more harmful to a person's long term health than being overweight. Consequently, we will now consider potential patients with a BMI of 27 or greater.

So, do you have a BMI of 30 or more? The following chart outlines your height against the weight that would give you a BMI of 30, for heights between 4 feet 6 inches and six feet six inches. If you are over that weight, then you are a potential candidate for a gastric balloon. And you are in very good company. In the UK, some 25% of the adult population fall into this group.

 

BMI of 30 = "obese"
Height (inches)

 

 

54
55
56
57
58
59
Weight (lbs)

 

 

128
134
138
142
146
150
Height (cm)

 

 

137
139.5
142
144.5
147
149.5
Weight (kg)

 

 

58
61
63
64.5
66
68
Height (inches)
60
61
62
63
64
65
66
67
68
69
70
71
Weight (lbs)
155
161
166
172
176
181
186
193
198
204
210
216
Height (cm)
152
154.5
157
159.5
162
164.5
167
169.5
172
174.5
177
179.5
Weight (kg)
69.5
72
74
76.5
80
82
84.5
88
90
93
95.5
98
Height (inches)
72
73
74
75
76
77
78

 

 

Weight (lbs)
222
228
234
240
246
252
259

 

 

Height (cm)
182
184.5
187
189.5
192
194.5
197

 

 

Weight (kg)
101
104
106
109
112
115
118

 

 

 

Once you know that your BMI is over 30, then prima facie you are a candidate for a balloon. But there is a little more to it than that.

Lower age limit

Currently, you (probably) have to be 18 years of age or older to be considered for a gastric balloon in the UK. However, it is likely that this age constraint will lower with increasing experience of the technique.

Use of the gastric balloon in adolescents

In other countries outside the UK, the gastric balloon has been used to treat obesity in adolescents. As is now common knowledge and reported regularly in our newspapers, childhood and adolescent obesity is a desperately worrying problem and a very major health issue for the next generation. It is an epidemic already, and simply must be addressed immediately.

So might the gastric balloon have a role?

This is not the place for a detailed analysis of this issue, but in one larger study 17 adolescents had a balloon fitted for 6 months. Prior to placement, their average BMI was 37 - ie they were on average severely obese. During the six month placement period, they lost an average of 14.5 kg (32 pounds). This equated to a 57% loss in their excess weight, and a reduction of 5.1 in their BMI to 32 (ie now only marginally obese, on average).

Clearly, the simple and safe nature of the gastric balloon provides an attractive treatment option for adolescents suffering from obesity, who have already failed with more conservative dietary / behavioural measures. It most certainly works at getting much of the excess weight off quickly and safely. Further, it provides an excellent opportunity to start to address all the lifestyle, educational and behavioural issues necessary for successful long term weight loss in the special group of patients. It also allows us to initiate therapeutic programmes to be continued for many years following balloon removal.

The balloon is also considerably safer and less "life-altering" than the more extensive surgical options that are already being performed on this same age group, both here in the UK and elsewhere. This study shows that its place in the management of adolescents who are already obese or severely obese should be seriously considered and tested, and we believe that it will be used in the UK sooner rather than later.

With a gastric balloon we can address both the child's weight and the root cause(s) of their obesity whilst at the same time doing the very least amount of harm both to their body and to their psychology. The aim of the adolescent balloon programme (and the necessary long term follow-up) would be to turn them back into "normal" children with a "normal" relationship both with themselves and with food. This is in contrast to stomach / intestinal bypass operations, that rather force them to lose weight by making them eat very tiny amounts of abnormal puréed food for the rest of their lives. Not infrequently, they will also develop very troublesome vomiting and / or diarrhoea or other metabolic complications. These highly complicated dangerous operations are clearly designed to get the weight off, with units sometimes paying less (if any) attention to the root cause of the child's problem. Therefore, they can often serve merely to reinforce the child's insecurities, fears and "sense of their own abnormality" rather than to relieve them. The child may be considerably thinner, but still just as unhappy - if not more so.

After all, if a 15 year old can already be given a major stomach bypass in the UK (and they are), with all its attendant risks, complications and implications; why not a gastric balloon?

And as we always say to our patients:-

"Everybody with a BMI of 35 once had a BMI of 25; and everybody with a BMI of 45 once had a BMI of 35. Obesity is a chronic progressive disease measured in big numbers. And our children have much more time to get to those numbers and to suffer and die because of it."

Upper age limit

There is no specific upper age limit, and in many regards the suitability of an older patient will depend upon many specific factors, such as:-

* Their actual chronological age. At present, we tend to adopt an arbitrary cut off of 65 years;
* Their biological age. This means are they "younger than their years" or older;
* The reason for losing weight. There may be excellent medical reasons why it is important for any particular patient to lose weight. This might swing the balance towards using a balloon;
* The amount of weight they wish or need to lose.

Therefore, within this age range, the Intragastric Balloon might be recommended in any of the following situations:-

* Patients who have a specific reason why they have put on weight, and that reason has now gone (such as temporary immobility), and who wish to lose that weight quickly, efficiently, and safely;
* Patients with BMI's between 30 and 40, who therefore do not fulfil the NICE guidelines for any other obesity / bariatric surgery (including the adjustable laparoscopic gastric band);
* Patients with BMI's between 27 and 30 at first presentation, who are known long term yo-yo dieters, and that this BMI is their lowest and very difficult to maintain even for short periods. We would not recommend a balloon for patients with BMI's between 25 and 27;
* Patients with a BMI of 27 or more who are also suffering from a significant weight related co-morbidity;
* Patients with BMI's over 40 who simply do not wish to undergo a more major surgical procedure for their obesity;
* Patients with BMI's over 40 who are not fit enough medically to undergo more major obesity surgery;
* Patients with BMI's over 40 who need to lose weight before they are able to undergo other non-obesity surgery; such as heart bypass surgery, or joint replacement;
* Patients with very high BMI's who need to lose weight quickly before they are deemed a reasonable risk for more definitive obesity surgery, which can then be carried out after the balloon has worked and been removed

Other Considerations

Even if you match one of the groups above, you may still not be a suitable candidate for a gastric balloon if you suffer from or have had any of the following:-

* A large hiatus hernia;
* Previous gastric surgery;
* Previous abdominal surgery with known post-operative intra-abdominal adhesions;
* Strictures of the (oesophagus) gullet or throat;
* Any inflammatory disease of the upper gastrointestinal tract;
* Any tumours of the upper gastrointestinal tract;
* Conditions or drugs that predispose you to bleeding;
* Certain drugs, such as aspirin and non-steroidal anti-inflammatory drugs;
* Long term steroid therapy;
* Severe renal, hepatic, pulmonary or cardiac disease;
* Psychiatric disorders;
* Alcoholism or drug addiction;
* Women who are pregnant or breast-feeding.

Even if you do not suffer with any of the above (which to be honest very few prospective patients do), you are still not an automatic candidate for a balloon. It is very important that you understand each and every aspect of what the balloon does and why, and how you must work with it to ensure long term success.

Education, Communication and Motivation

are essential for the process to work properly, and represent the very cornerstones of our success at the National Gastric Balloon Centre. At consultation it will be for both you and your doctor to determine whether you are a suitable candidate.

Having said all that, the overwhelming majority of patients who do approach us for a gastric balloon are suitable candidates.

 

Clinical Experience with the BIB System

As we have already stated, at the National Gastric Balloon Centre, we utilise the BIB System; considering this to be the best and most researched intragastric balloon system available. Therefore, it is important that we now document the whole clinical experience with this system for our prospective patients.

Again, an important caveat.

At the time of writing this guide, there is at least one other intragastric balloon system available in the UK. The following discussion must only be seen to relate to the use of the BIB System. It has absolutely no relevance whatsoever to any other balloon system either available now or in the future. This is an extremely important point, and one that you must recognise.

The BIB System is a spherical silicone balloon placed within the stomach and filled, under endoscopic guidance, with between 400 and 700ml of saline. It is designed to remain within the stomach for up to six months and is then deflated and removed under endoscopic vision. The presence of the balloon within the stomach produces an early and prolonged sense of satiety after a small meal, thus enabling markedly reduced energy intake and weight reduction.

The concept of an intragastric balloon evolved from the desire for an effective non-pharmaceutical weight loss method and from observing the effect of naturally occurring bezoars (large balls of ingested material) on weight. The presence of a bezoar causes weight loss and weight is regained when the bezoar is removed.

The BIB was developed to incorporate the positive aspects of the bezoar concept with a physiologically and anatomically compatible design. There were many problems associated with earlier versions of intragastric balloons. An expert meeting was held in Tarpon Springs, Florida in 1987 and recommendations were put forth to guide the future design and utilisation of intragastric balloons. The BIB System as used at the National Gastric Balloon Centre was developed to incorporate, where feasible, these recommendations.

As it is filled through an external self-sealing catheter, the BIB expands into a spherical shape and is designed to float freely within the stomach. The initial balloon was designed for only 3-month placement and the maximum fill volume permitted was 500ml of saline. Since January 2000, the improved BIB System allows 6-month placement, and a fill volume of up to 700ml. The volume of saline inserted can be adapted to individual patient requirements.

The following review relates only to experience with the intragastric balloon AFTER 2000, when the new improved BIB System was utilised. This is the system used by the National Gastric Balloon Centre.

 

How Effective is the Gastric Balloon?

The first very important point to make is that studies have consistently demonstrated significant weight loss in subjects treated with the BIB System. More than 20,000 BIB Systems have been implanted worldwide, with excellent outcomes.

Essentially, there are three ways of assessing the outcome from any weight management programme:-

* Actual amount of weight lost in pounds or kilograms. This may seem the most logical way of doing it. However, it is common sense to recognise that a loss of (say) 56 pounds or 4 stones in somebody weighing 16 stones before is considerably better than the same loss in somebody weighing 30 stones before.
* Percentage of Excess weight lost. This means adopting some form of assessment of so-called ideal or target weight (eg BMI), and seeing how much of that excess weight is lost during the treatment programme. This technique does have some merits over actual weight loss, but also has it's disadvantages.
* Change in BMI during the treatment programme. The primary disadvantage of this technique is that relatively large amounts of weight need to be lost for the loss of each unit of BMI.

Over the years the centres specialising in the use of the BIB System have reported their results utilising one, some, or all of these techniques.

A detailed analysis of all these reports would probably double the size of this book, be mostly incomprehensible, and do little to add to the following simple chart. This graph looks at the percentage of the patients' excess weight that is lost in the six months the balloon is in the patient's stomach, and relates that loss to patients in particular BMI groups.

 

However, the balloon system does have its sceptics and detractors, as do many innovative and simple medical advances. Many say that the balloon is simply a psychological crutch for those who do not have the willpower to lose the weight themselves. It is their contention that it is the support systems put in place to make the balloon work that in fact do all the work, and that the balloon is an irrelevance. Is this true?

In fact, this aspect has been studied by one of Europe's most experienced practitioners with the BIB System. He undertook a study in which patients underwent either:-

* Three months with a BIB in place, followed by 3 months in which they did not know whether the balloon was still in place or not; or
* Three months where they did not know whether a balloon had been inserted or not, followed by three months with a BIB in place.

The results showed that when the BIB was in the stomach, the patients lost on average 14.4 kg in the 3 months. Further, when the balloon was not in place, they only lost about 3kg during their three months on the other parts of the programme. Don't forget, none of these patients were told whether the balloon was there or not during each three month period of the trial.

Do you really need a concurrent programme to assist with weight loss and weight maintenance when you already have a balloon in place?

This is the opposite of the last question, which proposed that the balloon was irrelevant and that the dietary and behavioural changes did all the work. This next section poses the question - does the balloon do all the work, and do you really need anything else to make it work?

Throughout all of the gastric balloon literature, many authors have emphasised the importance of combining the BIB system with other weight reduction and management programmes. Amongst experts in the field, it is generally held that such programmes are not only desirable, but essential. At the National Gastric Balloon Centre, we wholeheartedly concur with this approach. We believe that any such programme should combine elements such as:-

* Dietary modification;
* Exercise;
* Behaviour changes;
* Maximising weight loss during the 6 months the balloon is in place;
* Maintaining lost weight once the balloon is removed.

The key to any long term weight management programme is to induce the behaviour changes necessary to maintain weight losses once achieved. This is the challenge that faces all of us working in this rewarding but difficult field. Any treatment option (be it drugs; the balloon; or more major surgery) that fails to address these issues is unlikely to meet the expectations of obese patients.

It is thought that four key elements may improve the chance of long term success:-

* Set realistic achievable (even modest) target goals;
* Use techniques for behavioural changes from the outset, and continue them long term;
* Develop a flexible eating pattern rather than a dictated rigid one;
* Reinforce the behaviour changes by continued diary keeping of many aspects of the patient's behaviour for the rest of the patient's life.

 

 

 

 

We believe that at the National Gastric Balloon Centre we have incorporated all of these elements (and more) into our unique and exclusive balloon programme.

 

 

 

So the answer is plain and simple. The intragastric balloon DOES work. It DOES result in significant weight loss. But it DOES require expert support, monitoring and advice for the patient to achieve the very best results, both in the short and medium to long terms.

And that is precisely what we do at the National Gastric Balloon Centre.

 

 

What is the pattern of weight loss with the balloon?

The pattern of weight loss with an intragastric balloon is as variable as the patients who consult us.

However, after much experience using the balloon alongside the Regenesis Diet and Weight Management System, we have found the following to be a pretty common pattern amongst our own patients:-

* During the first four to eight weeks, the weight loss can be dramatic. Many patients loss one to one and a half stones during this initial period. This is as much to do with the mechanics or the Regenesis Diet as it is getting used to the gastric balloon. This is very significantly more loss than with conventional diets, and gives our patients an excellent "kick start".
* Thereafter, the weight loss is steady, rather than precipitous. Again, most patients lose 2 to 3 pounds most weeks. This compares extremely favourably with conventional diets, and is achieved through eating sensibly, rather than through a fad diet. This is just one of the major advantages of the stomach balloon system.
* Men with significant abdominal fat and girth tend to lose the weight quicker and more consistently than women.
* Women with a very significant gynaecoid body fat distribution, so-called "pear-shape", generally lose the weight somewhat slower.
* Periods of significant plateauing are less common than with conventional diets.
* However, there will be occasional weeks when no weight loss occurs. This is nothing to worry about.
* Further, in our experience, even short periods of minor weight gain are surprisingly unusual. Most patients, at worse, merely maintain their weight loss. Many find this very reassuring at times when they may have fallen off the wagon somewhat.
* Even holidays and special occasions generally do no more than slow or halt the weight loss, rather than resulting in significant weight gain. Again, this is because of the behaviour changes that the stomach balloon allows us to achieve in a relatively short period of time.

 

 

 

The following chart is that of our own Director for the two months after insertion of his own stomach balloon and use of the Regenesis Diet and Weight Management System. It is a good example of many patients' experience during this initial phase.

The red line represents a loss of one pound per day. The blue line represents his actual loss.

Generally, we are aiming for an overall average loss of between a half a pound and one pound per day during this initial period.

 

 

Your Initial Consultation

At your initial consultation, it is imperative that we find out all we need to about you, and that you find out all of the information you could possibly wish to know about us and the BIB Stomach Balloon System. We actively encourage you to bring a spouse, partner or friend along with you. Having perused the various booklets and web sites relating to the gastric balloon, if you have any specific questions you wish to raise please write them down and bring them with you to the consultation. Otherwise, you are likely to forget to ask them! In fact, we pride ourselves that we are extremely likely to have answered them anyway by the time the consultation is over. Feel free to make notes.

During the consultation, which will take as long as is necessary, and is usually about 45 minutes to one hour, we will talk to you about the following:-

* Why you might be overweight now;
* Your previous weight history;
* Things you have done in the past to lose weight, and why they either failed outright or worked for a while;
* Your previous and current medical and surgical history;
* Your family / social / occupational history;
* Your sleep patterns;
* Why you are here now;
* Why you think that the balloon might be right for you;
* What you are trying to achieve and why;

The whole aim at this stage is to determine that your own expectations are realistic. If they are then it is highly likely that you will be extremely pleased with your balloon.

Having decided that you are a suitable candidate for a balloon, we will then have recommended a treatment plan. For almost all patients this will simply consist of the intended balloon placement and a date for it. However, for a very few it may include such aspects as:-

* any pre-insertion preparations required of the patient;
* what, if any, pre-insertion investigations are necessary;
* whether any specialists that you may have seen previously need to be contacted prior to insertion;
* whether we require you to see any other specialists prior to insertion;
* whether two or more sequential balloons may be anticipated; and if so, the length of time recommended between procedures;
* any other aspects that might affect the timing of the procedure(s);
* which, if any, medications must either be stopped or commenced prior to insertion, and from when;
* type of additional anaesthesia;
* day case or overnight stay.

Following this, we shall discuss the BIB Stomach Balloon System in detail with you, highlighting the issues discussed in this book. Consequently, following this initial consultation, you should have a very clear picture of what your proposed balloon entails; and what it might achieve for you. However, if you are still unclear about ANY aspect, contact us immediately. And as ever, if you think of any additional questions, write them down before you forget them!

 

 

Timing of your balloon placement

In deciding upon the timing of your balloon placement, there are several aspects to which you should give due consideration:-

* the full balance of your fees will have to be paid prior to the date of your procedure;
* depending upon the nature of your work, you may require some short time off;
* Use COMMON SENSE!
* If your work is extremely physical, you may require more time off work.
* If your work involves driving you may find that your Company's Insurance cover is invalid if you do not inform them that you have had a recent procedure.
* Do NOT arrange to undergo balloon placement in the few days prior to an important life event (e.g. don't have it done two days before your daughter's wedding!).
* You may need a little help with childcare for some days following the procedure.
* It is often a good idea to take a week's vacation to recover and recuperate from any medical procedure. However, you should also consider the following:-
* Ensure that your travel insurance covers you for complications arising in the early post-insertion period;
* Long haul flights may be more uncomfortable;
* Long haul flights may increase your risk of deep vein thrombosis following insertion if you get dehydrated;
* Very hot climates may actually make you feel worse; lead to dehydration and other potential risks arising therefrom etc;
* You will need to arrange transport both to and from the hospital. For reasons that should be obvious, you will not be allowed to drive yourself home or to travel alone on public transport.
* A suitably responsible adult, who must be made known to the nursing staff PRIOR to you going into theatre, must therefore escort you from the clinic. Should you not be able to provide us with details of a responsible adult, then your procedure WILL be cancelled. This will inevitably result in disappointment, and may incur additional costs.
* If you think of any more questions, write them down as soon as you think of them, and make sure that you get them answered before the balloon is inserted. No matter how silly you might think your concern is, you can rest assured that we wont. Information is everything. Ask away!;
* Please, please, please don't think of your last few days / weeks "of freedom" as an excuse to binge out. Patients very occasionally do this, and it often represents a disastrous start to their programme, from which some never really recover;
* Arrange any time off work that you might need. Many patients (especially men) do not need any time off work. But be prepared to have to take a few days;
* Ensure that you have appropriate assistance to take you home after the balloon has been placed. You will have had sedation and a procedure - admittedly very minor, but a procedure nonetheless. If you do not have somebody to escort you home, your procedure will almost certainly be postponed, with any additional costs having to be met by you;

 

The week(s) before you have your Gastric Balloon inserted - preparing for your balloon

Once you have decided to proceed with an Intragastric Balloon, we recommend the following during the days or weeks before it is inserted:-

At all times, feel free to contact the clinic. We are well aware that, whilst it all may be routine for us, this is a whole new experience for you.

* If you develop any medical problem at all in the week or so before your operation, please contact the clinic immediately.
* If you can, it is best to avoid alcohol and tobacco for at least seven days prior to insertion;
* Prepare a suitable overnight bag. We recommend this even if you are having day case surgery, as you will almost certainly be. It should include nightwear; slippers; a dressing gown; your usual toiletries etc. Remember to include some reading material, and the contact telephone numbers for your transport home.
* Please remove any tongue piercings that you may have.
* If you are taking ANY medicines at all, please bring them all with you on the day of your operation. Your anaesthetist will need to see them.
* If you use an inhaler - BRING IT WITH YOU!
* Please make a note to advise your consultant if your last menstrual period was delayed or otherwise unusual.
* Ensure that, before you come into hospital, you have a supply of simple pain-killers (e.g. Paracetamol) at home. You will be prescribed all the other medication you will need post-insertion.
* Ensure that, before you come into hospital, you have already done any necessary shopping, and that you have a supply of food and drinks (especially still mineral water) that will last at least a few days.

 

It's the day of insertion for your Gastric Balloon

* If you are merely having sedation, as almost all our patients are, please do not EAT for 6 hours prior to your admission time. However, clear fluids (e.g. water, black tea, black coffee) are allowed up to 2 hours ahead of your admission.
* In the very unlikely event that you are having a general anaesthetic do NOT eat or drink anything for 6 hours prior to your admission time;

You will have been given an admission time when you booked your procedure. It is very important to note that this is NOT necessarily the time of your procedure. This is the time at which it is anticipated that you will be able to be admitted to the ward and prepared for insertion. The nurses also have several necessary tasks to perform in the period prior to your procedure. They have to formally admit you to the hospital; take your blood pressure, pulse, and temperature; get you prepared as necessary. An intravenous cannula will be inserted into a vein in your arm. You will probably remain in your normal clothes.

Your Consultant will also see you. This may occur in between his other cases. It is most likely that, barring emergencies, all the other patients on the list will also be having gastric balloons inserted or removed. You may have further questions that you might wish to ask him. You will also have to read and sign the Consent Form.

By and large, attempts are made to ensure that your wait is not too long, and generally the organisation works extremely well. However, with any surgical hospital delays can occur for any number of reasons. For your safety, we prefer to admit our own patients to NHS hospitals equipped and able to accept any surgical speciality and deal with most surgical problems. Consequently, emergencies may be admitted from time to time. We ask that you are patient, and that you understand that the nursing and other staff are doing their very best.

How is the gastric balloon inserted into your stomach?

Inserting, and for that matter removing, the balloon is a very simple matter indeed, taking only a few minutes.

Many practitioners demand that their patients have a full general anaesthetic for the procedure, but at the National Gastric Balloon Centre, such is our level of experience and expertise, we are usually able to insert the balloon without the need for even the most light of sedation. This allows our (very grateful) patients to go home very quickly indeed and with very few post-insertion problems at all. For those patients who wish for some sedation or even a general anaesthetic we are of course happy to oblige, but this is only a very tiny minority. It is our experience, and that of some of the larger centres in Europe, that these patients do in fact suffer considerably more problems in the first few days following balloon insertion. The procedure usually takes considerably longer, and can be much more traumatic.

Once you have been admitted to the unit, and are ready to undergo the procedure, you will walk into the endoscopy suite and be asked to get onto the trolley. A little local anaesthetic spray will then be sprayed onto the back of your throat. This works really well, but doesn't always taste all that great! A mouth guard will then be inserted between your teeth, and your Consultant will almost certainly ask you to try to not bite his fingers off! If you have requested sedation, it will then be given.

Your Consultant will then gently pass the endoscope through your mouth guard, down your gullet and into your stomach. He will first undertake a thorough examination of your gullet, stomach and first part of your bowel. If any abnormalities are found, your procedure may have to be abandoned. This is extremely unusual. Having examined the area, he will then pass the balloon into your stomach alongside the endoscope.

The stomach balloon is, of course, inserted into your stomach in a deflated state! It is attached to a very soft, very fine catheter that allows your Consultant to fill the balloon with the sterile saline. In the following two pictures, you can clearly see the balloon and its attached catheter.

 

 

Once your balloon is safely sitting within the stomach, your Consultant will then start to inflate it with saline containing a blue dye. He will do this under direct vision using the endoscope in order to ensure that the balloon is inflating nicely. Here you can see the balloon just beginning to inflate within the stomach.

 

 

Here, you can see the protective sheath just beginning to tear away.

 

 

 

Having filled the balloon with about 500 to 700ml of fluid. The catheter will then be gently pulled off the balloon, and its self-sealing valve will close. Your Consultant will then inspect the balloon again, ensuring that it is in the correct position, floating freely within your stomach, and that there are no leaks.

In the following picture, the endoscope has been slipped past the balloon and then the end of the scope turned back on itself to look at the under side of the balloon. You can clearly see that the circular self-sealing valve has sealed perfectly and that there are no leaks. This is a routine check that we undertake in all patients prior to finally removing the endoscope. The valve is the circular shape in the bottom left hand quadrant of the balloon. It is also radio-opaque, and so allows us to monitor its presence by X-Rays, in the highly unlikely event that this is necessary.

 

 

Following placement of the balloon, which generally takes about 10 minutes, you will be returned to the recovery area of the unit and allowed to rest or sleep for as long as you need. Most patients are discharged home within an hour or two.

 

The First Few Days

The very first thing to say is that it is very rare indeed (in fact, almost unheard of) for anybody to have a reaction to the balloon that might require its immediate removal.

However, it is also very important to realise that the first few days can be quite uncomfortable. If you were not prepared for the sensations and discomfort that you might feel, then it could be quite distressing. It is vital during this early period to have free and open access to your medical team. They will provide you with advice and reassurance that all is normal.

At the National Gastric Balloon Centre, it is our practice to telephone all patients every day during this initial period, rather than wait for them to get concerned about a particular problem and contact us. A few words of reassurance and a friendly expert voice to speak to are generally all that is ever required.

Many of our patients have friends or family who have also had a gastric balloon at some stage. Clearly, this can be of a great help in providing encouragement and support. However, at this stage it is important for patients to understand that the reactions of different patients vary markedly. Some find the whole process extremely easy, with very few symptoms. At the other end of the spectrum, a very few patients find the first few days really quite difficult.

I myself had very few problems, and was back at my desk within four hours of my balloon being fitted. I did this because I had to. Unexpected work commitments made this a necessity. I didn't feel wonderful, but it was not too bad. I had really quite uncomfortable stomach cramps and acid reflux for about three days, but I did not vomit at all. Not even once. That was my experience. Yours will be different. Some will be better. Some will be worse.

In fact, this is an important point, because our experience shows that (perhaps somewhat surprisingly) men tend to have fewer problems and complaints during this period. We have found that it tends to be women who have more of the symptoms and that they also tend to be a little worse in women too. So, what are the potential experiences during the first few days?

It is useful to think of your stomach as an active organ, rather than an inert, floppy, motionless bag. It can move and react to things happening to it. It doesn't have its own brain, of course. But it does have nerves within its wall, and muscles that can make it contract or allow it to expand as necessary. Nerve impulses from your brain can also affect how your stomach works, as can the hormones flowing around in your blood stream. Therefore, when the balloon is first inserted, your stomach receives a bit of a shock, to say the least! All of a sudden, it has something about the size of a pint pot sitting in it. Normally, your stomach is used to things entering it and leaving it again pretty quickly. If it can't break it up and send it merrily on its way downward into your gut, then it "knows" it can usually send it back straight back out of your mouth! But this new object does not seem to want to go anywhere. Consequently, it takes a few days for your stomach to adapt to its new companion, and during this period, it still tries to fight back. This "fighting back" may cause you to feel any or all of the following:-

* General abdominal discomfort;
* Upper abdominal pain;
* Waves of abdominal cramps;
* Nausea;
* A sense of heaviness or bloating;
* Vomiting;
* Diarrhoea.

All of these are perfectly normal at this stage. Be prepared for them. They WILL go away.

Therefore, during this early period, you should be on one or other of several medications to help with these symptoms. At the National Gastric Balloon Centre, we have devised our own unique "cocktail" of prescription medications to help our patients. This was heavily influenced by my own experience with the balloon. We usually commence these immediately the balloon is inserted, before the patient even leaves the hospital.

Perhaps the most important aspect of this early period is the avoidance of dehydration. Dehydration simply means a relative lack of water, and in balloon patients can result from a combination of the following processes:-

* Being nil-by-mouth overnight before insertion of the balloon, plus
* Not really wanting to drink anything because of discomfort or the fear of discomfort, with
* Vomiting if that does occur, and possibly also
* Diarrhoea if severe, particularly if
* The weather is also especially hot.

In a sense, I think that, during these first few days, my new balloon patients are very similar to other patients who may have had more major stomach or bowel surgery. In fact, I tend to manage them in much the same way. However, to reassure you, there are four really massive differences between you as a balloon patient, and somebody who has had more major abdominal surgery (and this includes all the other forms of obesity surgery - including the adjustable gastric band, EVEN if placed laparoscopically):-

1. You are not medically unwell at the time of insertion of your balloon, nor are you very likely to have any of the more hazardous complications of being more seriously obese;
2. You have not had a general anaesthetic, with all its potential risks and complications in overweight people;
3. You have not had your abdomen opened at all, not even with the laparoscopes used for the lap-band, and
4. We haven't actually done anything to alter the continuity or anatomy of your stomach or gut either

Consequently, you have almost zero risk for many of the complications of abdominal surgery in general, and bariatric (obesity) surgery in particular. These include (a not very exhaustive list):-

* heart problems; stroke; pneumonia; blood clots; abdominal infection; bleeding; leakage of gut contents; suture line failure; peritonitis; abscesses; perforations; wound breakdown; strictures; band erosions; band slippage; several repeated surgeries etc.

The list goes on and on, and is one of the very major advantages of the gastric balloon.

Now, it must be stressed that clinically significant dehydration is unusual after placement of the gastric balloon. However, it is a serious medical condition, and must be avoided at all costs, and treated immediately should it occur.

So, how do you avoid it? We advise all our patients to ensure that they make themselves drink small amounts of clear fluid regularly. I adopt a very similar pattern to that I used to employ with patients who had had open gastric surgery. This is modified regime is as follows:-

* No physical activity for 24 hours;
* Try not to have to cook for 24 hours. It may increase any sense of nausea;
* Drink 30 to 60ml of water EVERY HOUR on the day of insertion. This water must be sipped slowly, and only increased in volume if there is no nausea or vomiting;
* Drink 60 to 90ml of water EVERY HOUR for the next two days;
* As you feel able, during the first 72 hours you can substitute the water with flavoured fruit juices; milk; or watery soups;
* Avoid any solid food for the first 72 hours;
* After this 72 hour period, slowly start to reintroduce light sloppy foods, such as jellies; thicker soups etc;
* As you feel able, start to reintroduce more regular foods, but don't push yourself;
* Somewhere between one and two weeks, almost all our patients are taking a "normal" solid food diet;
* After 48 to 72 hours, you should feel able to undertake more regular physical activity and exercise;
* After this first week, you will meet with the medical team to discuss your future care and diet.

The important point to realise here is that everybody is different. Every patient reacts a little differently to their new balloon. Some are happily taking a solid diet within five days. Others are still preferring a more liquid diet even at two weeks. So long as they are receiving adequate fluid and nutrition, this is perfectly OK.

 

You've Got Through The First Week!

Firstly, congratulations. The chances of you not having enormous success with your new balloon are now almost nil.

But, and it is a really important but, as should have been discussed at your consultation, the placement of the balloon is just the start of one of the most important six months of your life. To become a success and to maintain that success will require you to make a number of changes to various aspects of your life. You must grasp this opportunity with both hands and with all the enthusiasm you can muster. Promise yourself that, in years to come, you will look back on this period as one of the best and most valuable of your adult life. The period when you made the changes that altered your life for the good, and for ever.

 

 

The Next Six Months

The manufacturers of the gastric balloon refer to it as being a "training tool" - "like training wheels on a bicycle". This is true. All of us who work in the field on obesity medicine and bariatric surgery know full well that our patients are highly adept at cheating and getting around their treatment. This may sound surprising to you, that somebody would go through all the trauma of anti-obesity surgery only to cheat and prevent it working. But they do. Here are two anecdotes to prove a very important point.

At the end of the 1980's, I was involved in the care of a super-obese patient who was requesting obesity surgery to help her. After much counselling and preparation, myself and my colleagues undertook an open vertical banded gastroplasty. At that time, laparoscopic surgery was rare in the UK, and obesity surgery even rarer. This operation required a long incision and for us to place a line of staples along her stomach along with a non-stretchy restrictive band. It was very risky stuff indeed. In fact, I remember asking her if she was willing to take the risk of dying to have the operation. Such were her problems through her weight that she was able to answer "yes" to that question. Her surgery went brilliantly. She recovered really well. Her staple line healed perfectly, and she was able to start to take clear fluids. On her fifth post-operative day, I was called back to the hospital in the middle of the night. She had become acutely unwell. When we x-rayed her abdomen, her staples were now all lying free in her abdomen. It turned out that she had had one of her family bring a bottle of cola into the hospital for her, and she was sneaking drinks of it. In fact, she had had almost a whole bottle during the course of the day. In doing this, she had blown her staple line apart, and made a huge hole in her stomach. I took her to the operating theatre, and sucked the cola out of her abdomen. We tried to repair her stomach. Unfortunately, she died the next day.

I also recall a second patient who similarly underwent an open vertical banded gastroplasty. Again, all went perfectly well with the surgery. One day, a nurse noticed that the nasogastric tube that was on the patient locker next to this particular patient had gone. She just went and got another. A nasogastric tube is a soft plastic tube inserted through the nose into the stomach. It allows nurses to either aspirate fluid out of the stomach, or inject fluid into the stomach. It is commonly used in surgery. A couple of days later, another nasogastric tube went missing. After a bit of detective work, it turned out that our obesity patient was passing this tube through her own nose into her stomach, by-passing the staple line and the restrictive band so that she could inject a mixture of cream and liquidised chocolate bars directly into her stomach. She was having a friend bring this mixture in for her! Fortunately, she survived.

The whole point of these two rather extreme stories is that ABSOLUTELY ANY anti-obesity treatment (be it medicine or surgery) can be got around with sufficient motivation and ingenuity. Of course, pre-operative counselling and assessment should identify these patients beforehand, but it isn't that exact a science.

The gastric balloon is a fantastic tool for us to use. But it is only that. If the patient has a mind to get around it, then they will. Consequently, at the National Gastric Balloon Centre, we adopt our own exclusive four-tier programme for our patients. The NGBC Gastric Balloon Programme™ is as follows:-

 

The Regenesis
Behaviour Programme™
+
The Regenesis
Food and Eating Programme™
+
The Regenesis
Exercise Programme™
+
The NGBC
Support Programme™

=

The National Gastric Balloon Centre's
Balloon Programme™

=

Your very best chance
of long term success

 

By adopting this specially designed gastric balloon programme, our patients are best able to make a long term success of the time they have with their balloon and thereafter. We shall discuss the individual elements of the programme shortly.

I believe that the keys to success with the gastric balloon rely very heavily on the follows:-

* Completing your own personal NGBC Workbook as thoroughly and assiduously as you can;
* Attending ALL review consultations;
* Writing down EVERYTHING. This is a habit you should also adopt for the rest of your life. It's been proven to work in achieving long term weight loss;
* PLAN, PLAN, PLAN!!! Plan your day; plan your week; plan your life. Your success depends on it;
* And keep analysing and thinking about what you are doing and why; what you are eating and why; what upsets your eating apple cart and why; and how you can control it. In summary - get to really know yourself. Get to really like yourself. Do this and successful control of your weight WILL inevitably follow.

Following the first week, when you may still be contacted daily as necessary, your periods of follow-up will depend on your own needs and requirements. Most patients only need to be seen on a monthly basis, perhaps with a weekly phone call in between. The underlying principle here is that everybody's needs are different, and at the National Gastric Balloon Centre we will tailor-make your own programme to suit your own needs. Further, as you progress and your requirements change, we will amend and adapt your programme accordingly.

Should your weight plateau, or if you are finding hard to get started, then we also have exclusive access to the Regenesis Accelerated Weight Loss Programme™ to help you on your way.

As we always say, attention to detail is everything.

 

Your Last Few Weeks With Your Balloon -
preparing for its removal

During your last month with your balloon, we will start to see a little more of you again in the clinic. This is so we can start to address any remaining issues you might have relating to your new relationship with food. We shall also highlight the very great importance of seeing the last five months or so as being just the beginning of your lifelong management.

Remember, you are now well on your way to being in complete remission of your obesity, but you will NEVER be totally cured.

During this final few weeks, we shall discuss with you what to expect when the balloon is removed and how we want you to manage and control yourself during the first couple of months without the balloon.

 

It's time for your balloon to come out!

For you, removal of the balloon will be very much the same process as putting it in was. We refer you back to the earlier section relating to what to do prior to the balloon being placed. The following are the very few specific instructions relating to having your balloon removed:-

* One week before your balloon is removed, switch to a semi-liquid / semi-solid diet;
* Take only a liquid diet for 2 days before removal;
* For the last 24 hours prior to the removal, take still water only, with one exception. The evening before removal drink one can of coke to clean the balloon;
* No other liquids for 12 hours prior to the procedure;
* All the other usual instructions about having somebody accompany you to the clinic and to be with you thereafter.

Following removal of the balloon very few, if any, patients notice any adverse effects whatsoever. However, all the risks and potential complications of an upper GI endoscopy again apply (see below).

At the time of removal of your balloon, your Consultant will again have a look in your stomach to ensure that all is well. If he sees food in your stomach (very unlikely with the preparation we at the NGBC advise), he may have to stop the procedure and reverse your sedation in order to suck out any residual food contents with you full awake. This is a precaution we insist upon for your safety so that you do not inhale any of the food. It is rarely necessary.

After the balloon is removed, we recommend the following:-

* Ensure adequate fluid intake during the first 24 hours after removal;
* Return to your new eating pattern as soon as possible;
* Stop ALL your balloon medications one week after removal;
* During the next six months attend the National Gastric Balloon Centre as arranged for further review and support (see below).

 

So, your balloon is out. What happens next?

With many gastric balloon providers, once the balloon is removed that is the end of their dealings with you. At the National Gastric Balloon Centre we consider this to be both medically wrong and also a huge missed opportunity for our patients. Consequently, in your initial fee package for your balloon we include six months extra follow-up on our NGBC Support Programme and membership of the NGBC Club. We then strongly advise all our patients to remain with us indefinitely. We believe this provides our patients with a unique and exclusive personal service that will do most to ensure that their hard earned weight loss is maintained, improved upon and managed for the rest of their lives.

So, what is the NGBC Club?

 

 

 

 

The NGBC Club™

 

At the National Gastric Balloon Centre, we offer a lifetime of long term support for our patients through our on-going support programme. We would expect to review our patients at quarterly intervals through membership of the NGBC Club™. The fee for your balloon includes your first 6 month's membership. Membership thereafter is £200 per annum, and entitles you to:-

* The NGBC Support Programme™ with regular 3 monthly follow-up in the clinic, just as you would expect for any other incurable chronic disease, such as diabetes or asthma. Our patients find this quarterly review to be an incredibly useful aid to help them:-
* keep the weight off that they have already lost;
* continue their progress and lose even more weight; and
* spot any problems relating to weight gain and nip them in the bud.
* Access to the Regenesis Accelerated Weight Loss System™. This is a four week medically supervised programme, and is exclusive to the NGBC;
* Patient Support Group Meetings to allow for the sharing experiences, encouragement and advice between patients; both present and past;
* Regular Newsletters about what is new in the field of obesity and weight management;
* Family Membership of the NGBC Club. Many of our balloon patients have other family members and friends who also suffer with weight problems. We offer a range of other treatment options for those family members who do not qualify for a gastric balloon for whatever reason, and are pleased to be able to offer (where clinically indicated) gastric balloons at a discount;
* Our NGBC Referral Reward System™ for past patients who refer friends or acquaintances as new patients for a gastric balloon;
* The NGBC Privileged Patient Reward™ for any subsequent gastric balloons the member may require. For example, patients with higher BMI's often opt for sequential balloons rather than (say) a gastric band or bypass. We are pleased to be able to offer this exclusive service at a significant discount.

As one of our patients remarked, for roughly the same amount as she paid for her balloon, she could get another 25 years of additional support and other benefits to maintain her weight loss. She had previously spent a fortune on lots of other diets. She considered £4 per week to be a small price to pay for her regular follow-up and life long maintenance.

Are there any complications of the Gastric Balloon?

As with any medical procedure, there are potential complications. However, with the gastric balloon these are very few. In fact, that is one of its great advantages over other more invasive anti-obesity procedures and medications. Let's discuss each in turn.

Complications of having an upper GI endoscopy

To have the balloon inserted and removed, you must have a telescope passed through your mouth into your stomach so that your doctor can inspect your gullet and stomach. This is a very common out-patient procedure done every day in our hospitals, and is exactly the same as any other upper gastrointestinal endoscopy you or a family member may have had previously.

The complications of this procedure include:-

* A reaction to the sedative or local anaesthetic drugs;
* Sore throat;
* Damage to teeth;
* Abdominal discomfort because of the air pumped into the stomach to distend it;
* Injury to the gullet or stomach (including perforation -very rare);
* Inhalation of gastric contents (very rare);
* Cardiac or respiratory arrest (extremely rare)

The key here is to have an expert endoscopist undertake both insertion and removal of your gastric balloon, and a medical team experienced in looking for and managing any of these very unlikely complications. At the National Gastric Balloon Centre, we have a team of highly experienced NHS Consultant Physicians and Surgeons undertaking all our procedures, and a unique relationship with the NHS. ALL balloon insertions and removals are undertaken in an NHS endoscopy unit with full medical back-up in the very unlikely event that it might be required. Should any complications ensue, our patients are able to be admitted directly to an NHS hospital under NHS Consultant care. This will probably never be required, but it is a very significant advantage for our patients.

Complications relating to having the balloon in your stomach

The gastric balloon is a foreign body sitting within your stomach; an organ that secretes acidic gastric juice. This is potentially both an unwanted intruder for your stomach, and a hostile environment for your balloon. As a result, there are several potential complications relating to this. For completeness, the following is a list of all those reported in the world literature to date. The great majority of these have only been reported in isolated individuals or very small numbers in any particular series. Where possible, in our discussions, we have tried to give an indication of their prevalence.

* Psychological balloon intolerance
* True balloon intolerance
* Dehydration
* Metabolic problems +/- renal failure / thiamine deficiency
* Reflux oesophagitis
* Gastric erosions +/- bleeding
* Gastric ulcers +/- perforation
* Gastric outlet obstruction / balloon impaction
* Acute gastric dilatation
* Balloon deflation
* Spontaneous evacuation of the balloon at stool
* Intestinal obstruction
* Infections

Has anybody ever died after having a gastric balloon? The answer is yes. It is unbelievably rare. In fact, almost all of the series so far published report no deaths whatsoever. In the largest multicentre study yet carried out, 2,225 patients with BIBs were reported. In this very large series, there were 2 deaths. This equates to a percentage mortality rate of 0.089%. But any deaths are clearly disastrous, so let's briefly look at the two unfortunate cases in question. Both died following gastric perforation during their time with the BIB. In fact, both had also undergone gastric surgery previously. Consequently, at the National Gastric Balloon Centre, we would not recommend such a patient for placement of a balloon in the first place.

In fact, when the outcomes of the first 25,932 balloons were studied across the world, there was a total of only 8 deaths; equating to a mortality rate of 0.03%. Half of these deaths occurred in super obese patients, in whom the mortality and morbidity rates of ANY procedure are well recognised to be considerably higher. Rarely do such patients ever get recommended for a balloon, and are a tiny fraction of our practice at the National Gastric Balloon Centre. So, if the super obese are excluded, the mortality rate of the balloon appears to be of the order of 0.015, or 1 in about 7,000 cases.

We shall now discuss some of the other potential complications.

Persistence of symptoms – Balloon Intolerance

Persistence of these symptoms constitutes a significant complication that requires premature deflation and removal of the balloon.

Prior to November 2003, such balloon intolerance has been addressed by 12 observational studies with a reported incidence of 0.3 – 16.7%. The median prevalence reported was 7.5% with a mean prevalence of 5.6%.

In studies published since November 2003, balloon intolerance has been addressed by 5 additional single-centre studies with a reported incidence of 4.8 – 9.5%. The median prevalence was 7.3%, with a mean of 8.1%.

In the 2 large multi-centre studies, the median rate of balloon intolerance was 1.95%, with a mean of 0.9%. However, these may have been underreported.

A significant issue here is what constitutes intolerance. At what time or with what severity should the balloon be removed? The differing rates reported may reflect varied protocols concerning post-placement care and possible cultural differences.

The removal of the balloon in a patient with intolerance presents some important considerations. First, inadequate intake or persistent vomiting may have led to significant dehydration, electrolyte imbalance or renal issues. Consequently, great care must be taken to prepare these patients for removal – including the anaesthesia.

Secondly, balloon intolerance implies impairment of normal stomach emptying. No matter how long the patient has fasted, the stomach must be considered as if it contains significant intragastric food or fluid. Aspiration of gastric contents has presented as a serious complication of BIB System placement, but is very rare.

 

 

Spontaneous Deflation of the balloon

Spontaneous deflation of the balloon has been reported in most series, but most commonly when the balloon is left within the stomach longer than the manufacturer’s recommendation of six months. Your balloon contains a blue dye within the saline filling. In the incredibly unlikely event that the balloon does spontaneously deflate, you will notice that your urine will turn a blue / green colour. Please note carefully the following:-

* As long as the balloon comes out at six months, the chance of your balloon deflating is almost nil;
* It is therefore very unusual for it to deflate, but if it does the chance of it doing you any serious harm is almost nil;
* This is because we have a reasonable period of time to remove it through your mouth as we would normally do;
* This is because it takes some time for the deflated balloon to leave your stomach- maybe days. If your urine changes colour, contact us immediately;
* In the very unlikely event that your balloon leaves your stomach, in almost all cases it will pass along your gut harmlessly and come out at the other end with your stool;
* The balloon has a valve that is visible on X-Rays, so we are able to watch its passage over a few days if necessary;
* This is because it is extremely rare for it to cause a blockage in your gut, as long as you do not have a history of significant abdominal surgery and post-operative obstructive adhesions prior to the balloon being placed. At the National Gastric Balloon Centre, we would not even allow you to have a balloon with such a history;
* In the extremely unlikely event that it causes a blockage of your gut, it will very often be possible to remove the balloon through simple keyhole surgery;
* In a tiny handful of cases throughout the world, more major open surgery may be necessary to retrieve the balloon.

So, in summary:-

* Almost none will spontaneously deflate during the six months placement period;
* Of those very very few that do, almost none will get time to leave the stomach before they are removed by us;
* Of those very very few that do leave the stomach, almost all will pass out in the stool;
* Of those very very few that don't, the vast majority will be able to be removed via keyhole surgery;
* Of those very very few that aren't able to be removed through simple keyhole surgery, an open operation will be required

Therefore, should you suffer a spontaneous balloon deflation, do NOT panic! There is nothing to worry about at this stage. Merely call us and we shall make all the necessary arrangements.

Intestinal obstruction by the balloon

Therefore, this complication is very rare indeed. Much of this section was stated in the last, but it is well worth repeating and we make no apology for doing so.

Obstruction occurs if the balloon leaks and deflates whilst it is in the stomach. As we have just said, this is very unusual indeed, and to reiterate, in almost all cases the balloon would merely pass on down the gut and be passed out at the other end. Not very nice, but not at all dangerous. However, in a small number of deflations, the balloon may not be able to pass all the way down resulting in intestinal obstruction. This is a serious medical condition, which would usually require emergency surgery to remove the balloon. This removal might well be able to be achieved through keyhole surgery. In a small number of cases, more major open surgery may be required.

Consequently, in ALL patients, the saline injected into the balloon on insertion is stained with a special blue dye. Should the balloon deflate, the dye is released and is absorbed by the gut. This will colour the patient's urine a greenish-blue. Patients are warned to look for this, and if they see it they must contact us immediately. We would then arrange for the balloon to be removed in the conventional way before it has a chance to move further down the gut. In addition, it is very likely that such deflations are much more common if the balloon is left in for periods longer than six months.

Consequently, ALL our patients MUST have the balloon removed at six months.

In recent reports, it has been stated that the average rate of balloon deflation might have been as large as an average of about 9%. However, and of vital importance, when those deflations that occurred after the six months recommended placement time were excluded, the incidence of spontaneous balloon deflation fell by two thirds, to about 3%.

Some doctors and centres in the UK still do not follow this rule. Some routinely allow the balloon to deflate spontaneously and pass out with the stool. This might take 7 months; 9 months or even longer. Of course, as we have said, it almost always will pass out safely. But these practitioners are playing Russian Roulette with their patients' health and lives, and this practice is wrong. That is what we at the National Gastric Balloon Centre think. It is also what Inamed, the balloon's manufacturer, thinks. In the UK, two patients have died through gut obstruction because their surgeons routinely left the balloons in after six months to pass spontaneously. Or not, as the case may be. Totally avoidable. Totally unacceptable.

Inflammation of the lining of the gullet and / or stomach due to increased acid production.

Untreated, this could lead to ulceration, abdominal pain, bleeding, or even perforation. Consequently, ALL patients receive a very potent acid production inhibitor and an antacid for the whole six moths that the balloon is in place. This complication is therefore very rare, but very treatbale.

Bacterial overgrowth

Bacterial overgrowth of any clinical significance in the saline within the balloon is probably very uncommon. It might only be an issue if there was significant leakage of this fluid at the time of removal of the balloon. It is theoretically possible that this might then result in infection with fever, abdominal pain and diarrhoea. This is very rare.

What does your NGBC fee cover?

 

* All consultations;
* For our patients' convenience, we also offer a pre-insertion internet consultation service. However, this unique and exclusive service must be pre-booked, and a fee is payable in advance. We are happy to provide this via a webcam, upon request;
* All reviews with our team;
* Reviews over the internet are also available if requested by the patient, especially if geography makes this more convenient. We are happy to provide this via a webcam, upon request. No additional fee is levied for this service

In addition, unparalleled medical service, including:-

* The balloon itself;
* Any and all medications required for the six months the balloon is in place;
* Insertion and removal of the balloon by an NHS Consultant in an NHS Endoscopy Unit with full emergency medical back up in the highly unlikely event that this should be needed;
* A 24 hour 7 days a week Emergency Telephone Number direct to a member of our team;
* Full NHS support in the (again) highly unlikely event that you develop a serious complication during the six months that the balloon is in place;

Further, and exclusive etc

* A copy of the NGBC Guide to the Gastric Balloon. This is the only published guide to the balloon available and is exclusive to the NGBC. It contains a wealth of valuable information and tips, and is written specifically for patients in an easy to understand way;
* Your NGBC Monthly Workbook, which is an invaluable tool to monitor and sustain your long term progress;
* A copy of the Regenesis Diet and Weight Management System book, providing a mass of useful help and advice to make your balloon work even better. This is again exclusive to the NGBC;
* Your own National Gastric Balloon Centre Toolbox - containing amongst other things, an electronic Fat Monitor and a BMI calculator to help you monitor your own progress;

But, there's even more!

* Access to the Regenesis Accelerated Weight Loss Programme™ should you have a period of weight plateau during the six months that the balloon is in place. This is a four week programme of medically supervised, fast, safe weight loss and is exclusive to us;
* Your own personal and exclusive NGBC Club Membership Card. This explains that you have a balloon in place. Should you ever find yourself needing medical attention anywhere in the world, it provides your attending doctor with access to our web site and also to all our emergency telephone numbers should he require any advice or assistance at any time of the night or day. We ask you to carry it with you at all times. It also entitles you to all the other benefits of club membership outlined earlier;
* Your first subscription to the NGBC Club, including full access to the NGBC Support Programme and 2 further quarterly reviews after the balloon is removed;
* Six month's subscription to our sister organisation MyBigBuddy.com, an internet support service for the millions of us with weight problems;
* A years subscription to the British Obesity Surgery Patients Association (BOSPA);

Lastly,

* Interest free credit if required
* Other loans and financial assistance available

 

What if I have my endoscopy and you are unable to insert my gastric balloon?

As stated earlier, under normal circumstances this is extremely unusual. Patients with no previous history of stomach surgery very rarely surprise us by having anything significantly abnormal when we inspect their gullet and stomach.

However, we do occasionally find a large hiatus hernia, which will require treatment prior to any further consideration of a balloon, and may mean that any thought of one will have to be abandoned.

In addition, we do from time to time discover an otherwise symptomless polyp or other abnormality. In these cases, we would almost certainly biopsy or even remove the lesion in question. THIS WILL BE AT NO FURTHER COST TO YOU. The decision whether to insert the balloon at this time or to wait for the result of the biopsy is entirely at the discretion of your Consultant, based upon his vast experience of looking at such lesions.

Further, we may find a condition, such as gastritis (an inflamed stomach) that requires a short course of medical treatment before the balloon is inserted. This would of course mean an additional endoscopy.

Lastly, patients who have had previous stomach surgery (especially previous obesity surgery) do frequently consult us, and each poses an individual set of problems that must be discussed on an individual basis.

If, following endoscopy, we are unable to insert your balloon at all, including at any time in the future. This is extremely rare:-

* You shall receive a refund of £2,500

If, following endoscopy, you have a treatable benign condition that merely means your balloon placement has to be postponed, the decision of whether to be treated and then proceed is entirely yours. This situation is very unusual:-

* Should you wish to be treated and then proceed with balloon placement, your GP will be informed of the treatment that is advised so that he can prescribe it for you;
* A further fee of £750 will be due for the additional endoscopy required to place your balloon.

Should you decide not to proceed, a refund of £2,500 will be made to you.

 

What if I can’t tolerate the balloon and need it removing earlier, if not almost straight away?

As stated earlier, balloon intolerance is now a rare occurrence amongst groups with large experience. Unfortunately, there is no way that we are currently able to predict which patients are going to suffer from it.

Consequently, we wish to make it abundantly clear at this stage, prior to insertion of your balloon, that this is a risk that you must be prepared to take.

However, at the NGBC, all of our patients go through our own exclusive one-week pre-insertion programme to prepare for their balloon insertion. Further, we shall do all in our power to help you to get through the initial period and have a successful outcome with your balloon, including daily contact for as long as is necessary.

In the very unlikely event that you do suffer from significant balloon intolerance and request that we remove the balloon for you:-

* We shall remove the balloon;
* We will offer to continue your care for the rest of the year; including the Regenesis Accelerated Weight Loss System (normally £495 for each 4 week course), and the Regenesis Weight Management Programme. This will be at no further cost to you whatsoever.
* Alternatively, you may opt for a refund of £750 in lieu of the year of aftercare and follow-up;
* The remainder of your fees are unfortunately non-refundable.

 

What if my balloon deflates,
and I need to have it removed?

Again, balloon deflation is an unusual event in patients who take all their prescribed medication and who attend for balloon removal at six months. Should you suffer from this complication, you will notice your urine change colour:-

* YOU MUST ATTEND IMMEDIATELY;
* We shall remove the balloon endoscopically if, as is almost certainly the case, the balloon is still in the stomach;
* In the highly unlikely event that the balloon has already left the stomach, we shall monitor your progress closely;
* In the extremely unlikely event that the balloon obstructs your gut, we shall admit you to our associated NHS hospital, where you will be cared for by NHS Consultants under our unique and exclusive agreement. This will be at no extra cost to you.
* Both ourselves and the balloon manufacturers will be in constant contact with you about what to do next regarding reinsertion of a new balloon This will depend upon how long the balloon has already been in place, and your own wishes. If spontaneous deflation occurs during your six month period with the balloon, any further treatment will be free of charge.

 

 

 

 

 

IMPORTANT!!

 

AT THE NATIONAL GASTRIC BALLOON CENTRE, WE INSIST THAT YOUR BALLOON BE REMOVED AFTER SIX MONTHS.

THE FULL FEE FOR THIS REMOVAL IS INCLUDED WITHIN YOUR INITIAL ALL - INCLUSIVE PAYMENT.

SHOULD YOU FAIL TO ATTEND FOR BALLOON REMOVAL AT THIS TIME, ANY AND ALL COMPLICATIONS THAT ENSUE THEREAFTER WILL BE AT YOUR OWN RISK AND YOUR OWN EXPENSE.

 

And finally, does the balloon ever not work?

The truthful answer is simply "yes". But in a sense it depends what you mean by "work". Now, let's discuss this for a moment.

Firstly, I refer you back to the section where we discussed the cases of two patients who cheated after major obesity surgery. The gastric balloon will NOT prevent you from drinking high calorie sweet or fatty drinks. Clearly, you are not going to lose as much, if any weight if you do not adopt the lifestyle changes in regard to your relationship with food. Our NGBC Balloon Programme is specifically designed to help you with these changes, but it will require will power and discipline on your part. It's not that the balloon hasn't worked, it's more that the patient has not worked with it.

Secondly, with any medical procedure or biological process there is a range of results that are recorded. Some patients just naturally do better than others. Again, the NGBC Balloon Programme is specifically set up to maximise each patient's own potential for success. For some patients, this may include the use of the Regenesis Accelerated Weight Loss Programme at no extra cost to them. This almost always puts the programme well and truly back on course.

Therefore, we are unable to offer any refund in the event that patients are disappointed with the results of their gastric balloon. To be honest, very very few are disappointed. It's not always easy, but it is almost always successful!

About the Author

 

Dr Phill Thomas
MB ChB LLB(hons) FRCS

Director
The National Gastric Balloon Centre, UK

 

Mr Phillip Thomas holds degrees in Medicine and Surgery from the Victoria University of Manchester, and an honours degree in Law from the University of Leeds, both in the UK.

He qualified in Medicine in 1984, being awarded the Bradley Memorial Scholarship in Surgery. Thereafter, he entered general surgical training in Manchester, obtaining the Fellowship of the Royal College of Surgeons at the first attempt.

In 1988, he became the British Digestive Foundation Research Fellow, investigating enzyme changes associated with diseases of the pancreas (a gland intimately associated with the development of obesity). During this period, he was also actively involved in the development of surgical construction of a new rectum out of a pouch of small intestine following removal of the large bowel. On the basis of this work, he was awarded the Gold Medal for Best Scientific Paper at the first International Conference on Pelvic Pouch Procedures, and Visiting Professor of Surgery, University of Bologna, Italy.

Thereafter, he was appointed the first Tutor in Surgical Gastroenterology and Honorary Senior Registrar in Surgery at the University of Manchester, where he continued his work on pelvic pouches. He was also heavily involved in the (then) relatively new field of obesity surgery - including major open surgery and the initial development of the stomach balloon.

In 1991, Butterworth-Heinemann published his major surgical textbook, entitled "Pelvic Pouch Procedures", which has subsequently been re-published by Elsevier. He was also awarded the Merit Award by the Association of Surgeons of Great Britain & Ireland for his "contribution to surgical education". In addition to his textbook, he has also been extensively published in peer-reviewed scientific journals, and presented at many national and international meetings.

After surgical training, Mr Thomas left the NHS, and undertook legal training in Leeds, where he completed the honours degree after only two years of study. He then entered private legal practice, working with the UK's only totally dedicated medical law firm, working on several very famous medical cases. At this time, he also commenced private surgical practice, working within the field of weight management and body contouring surgery.

Ever since his late 20's he has struggled with his own weight, and having reached the weight of 18 stones, he had a gastric balloon placed in himself. This worked extremely well, and he has maintained almost all of the four stones he lost during the six month placement period. Following a period setting up a national obesity surgery centre in the midlands and acting as its Medical Director, he is now concentrating his efforts on the National Gastric Balloon Centre.

He is a regular broadcaster on television and radio, and has appeared in numerous magazine and newspaper articles. He also is a regular advisor to the BBC and ITN on issue of obesity, especially in children and adolescents; and on the politics of obesity. He has recently been consulted by the BBC's "Casualty" programme relating to an episode they are planning on the gastric balloon.

 

The National Gastric Balloon Centre
www.stomachballoons.co.uk