Common Questions on Gastric Balloon Singapore

Singapore, despite being a city-island nation or a country built on the main island of its archipelago, Singapore has paved its way to becoming one of the first-world countries in Asia.

As a competitive country, Singapore has been known to become one of the most expensive countries to visit. One, for example, is their world-class city airport and a luxurious hotel, popularly known as the Marina Bay Sands.

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Moreover, as much as how foreign people love visiting Singapore, going out for leisure travels is a huge hobby for the locals especially, knowing that Singaporeans are hard-working people, traveling helps them get loose from stress.

By 2020, the world faced an unexpected visitor, and all countries had to exhibit quarantine protocols. And even for a rich country like Singapore, it wasn't easy to be prohibited from going out and visiting other countries to enjoy foreign cuisines. But thanks to the fast internet and food delivery apps, locals have found a way to comply with their cravings.

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Because of protocols including social distancing and community lockdowns, having a good internet service and food delivery apps became a perfect combination to live comfortably during quarantines. However, this also became an unexpected risk for these people as the behavior of food delivery apps went on.

One of the most common health issues that locals are currently dealing with, that can also increase their risk to Covid19 is obesity. As mentioned, Singapore is a place where food apps and various international cuisines are very accessible.

A new way of treating weight loss known as gastric balloon has changed the method of helping obese patients, and for them to have an option that has a lesser risk compared to surgery.

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Dr. Shanker Pasupathy, an ASEAN scholar of Raffles Institution and Raffles Junior College from 1984-1989, is now a senior consultant surgeon based in Singapore. Dr. Shanker Pasupathy pioneered the laparoscopic sleeve gastrectomy and laparoscopic gastric bypass at the Singapore General Hospital (SGH) in 2008. This was after completing his training in general gastrointestinal and vascular surgery in Singapore, Germany, UK, and France to acquire skills in advanced keyhole surgery techniques.

As a surgeon who has spent years studying gastric bypass surgery, laparoscopy, and robotic surgery, it is truly an honor to have his opinion and answers about the idea of the gastric balloon.

Dr. Shanker gave answers to frequently asked questions by many people who may have been curious after encountering the effect of the gastric balloon on the idea of weight loss.

Q: What is an intragastric balloon?

A: Intragastric balloon is a [weight loss] balloon that is placed inside the stomach to help someone feel full and reduce the amount of food that they need to eat to satisfy themselves.

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Q: Who is eligible to undergo balloon placement? What are the criteria they need to meet?

A: In Singapore, the criteria for placement for an intragastric balloon is based on a BMI of above 27. I also believe one should be above the age of 18.

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Q: Is there any age limitation for an intragastric balloon?

A: Yes, as I mentioned, it is not for kids. I think the products are licensed for individuals who are aged 18 and above.

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Q: Is there a cap on the maximum age limit?

A: Not that I know of, actually. I don't think there's a cap. However, we normally wouldn't talk about such interventions for obesity for older individuals, unless they are fit and healthy enough to undergo the procedure. But I don't think there is a licensing requirement stating that you cannot use a particular product beyond a certain age.

Q: What are the results of these procedures?

A: So, intragastric balloons are very useful to help people to kickstart their weight loss journey. Usually, for people who have a balloon placed, the average weight loss is between 10% to 15% of their body weight, depending on the type of balloon, obviously.

It's usually kept for a minimum of four months, specifically the new Allurion balloon, but some balloons can be kept for six months or even up to one year. Those are the other balloons, like your brand [Orbera] and spatz balloon, which are available in Singapore. As far as I know, these are the only three balloons available.

Q: Does this procedure require endoscopy?

A: Some balloons require placement by endoscopy, as well as the balloon removal. Currently, the only balloon that does not require endoscopy for placement or removal is the Allurion balloon.

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Q: Does this procedure require general anesthesia?

A: Normally, the endoscopy to place gastric balloon or remove gastric balloon is done under sedation, not under general anaesthesia.

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Q:What's the whole process of a patient undergoing this procedure? What are the common medications that they have to take a few days before? What will be the after effects for the first few days, what would they need to go through, and what will the patients need to do in case of side effects?

A: If someone has no specific problems related to the stomach or esophagus like reflux or ulcers, and they have not had any previous surgery or treatment on the stomach, then they would generally be eligible for the gastric balloon, if they’re above the age of 18 and, of course, have a BMI of more than 27.

The fasting is fairly straightforward for the actual placement of the balloon. All you need to do is an overnight fast or six hours fasting, and then the balloon can be placed. Some medication, usually given to control the symptoms of nausea and abdominal cramps, tends to accompany the balloon when it's placed. Those symptoms usually last for the first few days, rarely beyond a week or so.

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The most important reason why the balloon is placed is to kickstart the weight loss journey. So, I think, in that regard, it helps to control hunger and cravings. It can help people reduce impulsive eating and help them to control the amount of food that they eat. Because the balloon is there and remains there for several months, it helps them to feel satisfied by eating a little bit. Thus, food portions become smaller.

Q: Does intragastric balloon cause complications after the procedure?

A: Well, the gastric balloon actually is sitting in your stomach and remains in your stomach for several months. So, it will give all kinds of ill effects of something being in the stomach and unable to be removed. As you can imagine, there will be nausea, cramps, and feeling of bloatedness, and, sometimes, gas and burping. These are very common side effects you will experience. ‘Complications’ per se are extremely unusual because this is only a temporary treatment. The most important thing is obviously to identify anyone with pre-existing conditions that should not have a balloon. So, it's extremely unusual for you to have any complications beyond the expected side effects.

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Q: Is this procedure claimable through Medisave?

A: No. Gastric balloons are a medical device and, therefore, they cannot be claimed by Medisave.

Q: What about the procedure of placing an intragastric balloon, is it a Medisave claimable procedure?

A: For the placement of the Orbera and Spatz balloon, endoscopy is required and that portion is medisave claimable.

The balloon however is non invasive as such requires no endoscopy, no anesthesia and no surgery and reduces the overall risk!

In Conclusion:

Singaporeans may be afraid or do not know who to approach for assistance on weight loss, mainly due to misleading advertisements from weight management companies or “slimming pills or other products”. They offer up to 90% promotions or free trial on “weight loss packages” with before and after results that look like a dream come true. If it’s too good to be true, it might not be true.

Most of them are just a temporary solution, as shrink wraps and such treatments only help you to lose “water weight” & you will easily gain it back later. It is important to seek advice from a certified doctor for weight loss.

The main reasons that overweight & obese individuals are afraid of seeking help from doctors is because they relate doctors to surgeries and they are afraid. As mentioned by Dr.Shanker, there are intragastric balloons that require either only endoscopy (Orbera & Spatz) or an endoscopy free gastric balloon which comes in the form of a capsule so no surgery is involved.

Although the price of gastric balloon is higher as compared to going for weight loss treatments from weight management companies, gastric balloons are proven to be effective for weight loss. The Ellipse Gastric Balloon is proven through many studies to help patients lose 10-15% of their total body weight in just 4 months. If you are 100kg, that means you will be able to lose 10-15kg and combined with a little exercise you will be able to lose more than that!

So for those suffering from weight issues, it is best that you start as early as possible. Once your weight reaches a certain threshold, you might not be eligible for Gastric Balloons and your only option will be invasive procedures like Gastric Bypass & Gastric Sleeve. Please seek advice from a qualified doctor to assess eligibility for this program.

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