Bariatric Surgery: Gastric Balloon Singapore​

Weight loss has always been an interest to many people. However, nowadays, more and more are realizing that it is not that easy to shed off their weight by mere diet and exercise alone. That’s why new medical and surgical weight loss procedures have popped up, especially due to the advance technology within the health industry.

With that said, general opinion about these new bariatric solutions is fairly split. Some people are afraid to undergo invasive surgery for their weight loss. Others direct their concern on whether, or not, they meet the physical qualifications to have a safe weight loss surgery. As a result, more are considering alternative solutions for losing weight, such as gastric balloons.

Gastric balloons have risen in popularity in Singapore, considering the different types of balloon now available in the market. Even so, the procedure is relatively new and not a lot of people are fully aware about various aspects that go into having a balloon placed.

We invited Dr. Tan Chun Hai to help us know more about gastric balloons, what they are and how it can help you in your weight loss. Dr. Tan is a General Surgeon at Gleneagles Hospital, Surgicare Bariatric and General Surgery Clinic, and an Accredited Surgeon across all private hospitals in Singapore. His expertise includes bariatric and metabolic surgery, having performed and assisted in more than 500 cases of bariatric surgeries.You may learn more on his services HERE!

Q: What is an endoscopic balloon procedure?

A: An endoscopic balloon procedure uses an intragastric balloon, which means a balloon is going to be put into the stomach and it is done under the guidance of an endoscopy which we call gastroscope. So, we put in a flexible tube with a camera attached at the top to have a look at the stomach as we place this balloon into the stomach.

Q: What is involved in an endoscopy presume procedure?

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A: It involves the patient coming into the hospital, where we will perform this procedure in the endoscopy suite. We will perform an endoscopy to check the condition of the stomach and make sure that they are suitable to have a balloon placed. We then proceed to put in the stomach balloon and inflate the stomach balloon under direct vision.

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Q : When is there a need for endoscopy?

A: We can perform the endoscopy to have a look at the stomach conditions to make sure that they are suitable for a stomach balloon to be placed in.

Q: What brands [of intragastric balloon] are there in Singapore?

A: There is the obera 365 balloon as well as the spatz adjustable balloon. There’s also the Allurion Elipse. Those are the intragastric balloons that are available in Singapore.

Q: As spatz is adjustable, how big is it? How many cc can spatz be maximized?

A: I'm not sure about the volume.

Q: What’s the highest you can usually go?

A: I think up to 400 to 600 mils.

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Q: Does endoscopy have any side effects?

A: So, the risk associated with endoscopy that I explain to all my patients, is similar to the risk of sedation. The risk of sedation is minimal under supervision, including risk of heart attack, stroke, respiratory depression, and allergic reaction to the sedation material. Risk of endoscopy itself is only 0.1% or 0.01%, depending on whether it's a gastroscopy or colonoscopy. In the event of a perforation, the patient will require an emergency operation to repair the damage. Also, if there is a presence of polyp and biopsy, there'll be a risk of bleeding from the biopsy. Those are the main key risks for endoscopy.

Q: Are they also considered potential complications?

A: Yes.

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Q: Do we need sedation to undergo an endoscopic procedure?

A: It is advisable to perform gastroscopy or colonoscopy under sedation, in which the patient will not feel so uncomfortable. Having said that, we have also performed gastroscope and colonoscope with the patient not having any sedation at all.

Q: When is there a need for sedation?

A: When we perform a procedure, it can be uncomfortable for a patient and sometimes the patient does not want to experience those uncomfortable procedures. So, we can do proper sedation for the patient to perform the procedure safely.

Q: Are there any side effects of sedation?

A: Nothing other than the risks mentioned earlier. Those are the risks that we will usually tell our patients.

Q: What is the Allurion Elipse balloon?

A: It is the latest balloon that has come onto the market. It is a swallowable intragastric balloon that does not require the patient to undergo endoscopy to place it. It can be placed under radiological guidance, which means that we will use an X ray to determine and to confirm the position of the uninflated balloon within the stomach before we inflate the balloon safely.

Q: Who is eligible and what are the criteria to undergo the procedure?

A: People who have tried diet and exercise for a long period of time and have not been successful in keeping or maintaining their weight down can consider an intragastric balloon. Patients who are mildly overweight or in the obese category class one can also consider this. It means that patients who do not qualify for bariatric surgery or patients who do qualify for surgery but are not keen for such an invasive and permanent procedure can also consider intragastric balloons to either breach them. You can also consider an endoscopic balloon.

Q: What are the results of this procedure?

A: We can expect an average of up to 15% total weight loss, as long as the balloon is within the body. After the balloon is retrieved from the body or being passed out, which is the case for the Allurion Elipse balloon, we will warn the patient of the risk of weight regain. However, we will also support the patient with dietary and lifestyle modification in our multidisciplinary team with a physiotherapist and dietitians on board.

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Q: Does this procedure require endoscopy?

A: This procedure does not require endoscopy. It is a radiological guided intragastric balloon insertion procedure.

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Q: Does this procedure require general anesthesia?

A: No. None of the intragastric balloons that we use require general anesthesia. It can be safely done with sedation.

Q: What is the whole process of a patient undergoing the Allurion Elipse balloon procedure? For example, how many hours does the patient need to fast? How many days does it take before they need to take the medication?

A: We will prepare the patient for the intragastric balloon insertion usually a few days before the procedure. They are usually fasted for a couple of hours prior to the procedure itself and we will prepare them with some pre-medication to be started a few days prior to the day of insertion. They will come to either a X ray facility or an endoscopy suite facility for the balloon placement, and this is done a week with no sedation. They will remain in the X ray facility after the patient swallows the uninflated balloon that comes in a capsule like a pill form. Once we have confirmed the position of the pill in the stomach with an X ray, we will then proceed to inflate the balloon with saline. After which, we will again confirm the position of the balloon within the stomach again before making sure the patient is safe to go home after adequate time of monitoring. We will review the patient in the clinic a couple of days after the procedure.

Q: If a patient faces dehydration, and they come back to revisit the clinic for consultation, what would be the next procedure to be done?

A: I tell my patients that one of the things that worries me most after the insertion of a balloon is that patients may experience persistent vomiting. As a result, they dehydrate themselves and put themselves at risk of injuries. If they come back with severe dehydration, I'll try my best to tell them to improve their oral intake. They are then required to undergo some form of intravenous volume replacement with saline. They may need to stay in the hospital to be observed until they are safe to be discharged. It might take a day or two.

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Q: What are the possible complications for this procedure?

A: Insertion of the gastric balloon should be done by a trained specialist with knowledge of how to insert the balloon properly. Risk of inflating the balloon before it is in the correct position may predispose the patient to suffer oesophagus perforation. Inadequate insufflation of the balloon may also predispose the balloon to being placed in different parts of the stomach. The stomach may move on and deflate partially into the small bowel and cause intestinal obstruction. This can lead to a surgical emergency in which the patient needs to undergo a surgical procedure to retrieve the balloon. Rare cases include perforation of the small intestine, esophagus, and pancreatitis.

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Q: What are the side effects after going through this procedure?

A: We expect the patients to feel quite full with an intragastric balloon inside the stomach. Sometimes, the patient will feel nausea and vomiting for a couple of days after the procedure. It is more pronounced in the first few days compared to later on. I think, most importantly, nausea and vomiting needs to be controlled with medications that are part of our protocol. Also, [it is important] to make sure that the patient is adequately hydrated, because if there's any dehydration, the patient needs to come back early to seek medical treatment.

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Q: Is this procedure Medisave claimable?

A: I'm not sure whether this procedure is medisave claimable. I don't think so.

Q : With regards to possible complications, in the event if the patient have complications after placing the balloon, am they be able to claim from Medisave or other [healthcare program]?

A: The company that provides the Allurion balloon does have good support such that if there is a complication due to the process for the insertion of a balloon, they will have a refund policy. However, I think what is more important is the insertion of the balloon needs to be performed safely by trained specialists in a safe place. Monitoring and post procedure follow-up is also very important. Okay, thank you.