Gastric Sleeve Vs Balloon for Weight Loss and Diabetes

Gastric Sleeve Vs Balloon is a comparison of the two weight-loss interventions. A gastric sleeve is preferred by most patients, however, people who can not undergo a surgical procedure usually opt for a gastric weight loss balloon to lose weight.

Gastric Sleeve Vs Balloon:

Gastric Balloon:

Intragastric balloons placement for weight loss is a non-invasive procedure. This kind of procedure requires minimal sedation. It is performed while the patient is awake. In fact, the person can see when the endoscope is placed in the stomach.

Because of the non-invasive nature of the procedure, scientists are developing more advanced and less invasive methods of gastric balloon placement.

Various types of balloons can be placed in by numerous techniques, some can be simply swallowed and some to be placed with the help of an endoscope.

The three main types of gastric balloons are:

• Orbera gastric balloon:

  • It is inserted via an endoscope into the stomach. Once it is placed inside the stomach, it is inflated with saline.
  • The procedure is performed under light sedation and the person can go home the same day. The Orbera gastric balloon has to be removed after 6 months.
  • It is a single balloon and occupies about 550 ml of the stomach. This is equivalent to half of your stomach

• ReShape gastric balloon:

  • Like Orbera gastric balloon, ReShape gastric balloon is also inserted under light sedation via an endoscope.
  • Similar to Orbera gastric balloon, it is also filled with saline, however, unlike Orbera, ReShape gastric balloon has two balloons that occupy about 750 to 900 ml of your stomach. This is equivalent to almost 90% of your stomach.

• Obalon gastric balloon:

  • This type of gastric balloon is different than Orbera and ReShape gastric balloons. Obalon gastric balloon is not placed endoscopically, it is swallowed like a vitamin pill.
  • It has three different balloons that are swallowed at three different visits and inflated with air.
  • After 6 months, these balloons are all removed in one visit.

Laparoscopic Sleeve Gastrectomy (Gastric Sleeve Surgery):

On the other hand, laparoscopic sleeve gastrectomy, or simply Gastric Sleeve is a type of bariatric surgery.

Open Gastric Sleeve is rarely performed nowadays because it requires a large incision that may look very unsightly.

Laparoscopic sleeve gastrectomy or gastric sleeve is performed under anesthesia. It requires three small incisions that may look like small scars.

Laparoscopic sleeve gastrectomy requires a multi-disciplinary approach. It requires an experienced surgeon to perform the surgery, pre-operative and post-operative nutritional assessment, and basically a whole team.

Gastric Sleeve Vs Intragastric Balloon: How Do They Help You Lose Weight?

Intragastric Balloon:

Intragastric balloons act by occupying the stomach interior. It basically acts as a space-occupying device. It makes a person feel full all the time.

The area that is used to store food is filled with an inflated balloon. This leads to early satiety and reduces your appetite.

The balloon in the stomach will give a false signal of the presence of food, eventually leading to weight loss.

Laparoscopic sleeve gastrectomy:

Laparoscopic sleeve gastrectomy acts by reducing the total volume of the stomach permanently. When the volume is reduced, less food is going to enter or get stored and you’ll feel full soon after you start to eat.

Specialized devices (staplers) resect part of the stomach completely, permanently reducing stomach volume.

This procedure not only alters the stomach volume but also alters the Gut-Brain Axis (neuroendocrine axis).

The brain gets signals that the stomach can not accommodate food, causing suppression of appetite. This way, it reduces the craving for foods that have a high glycemic index.

Gastric sleeve is not only associated with weight loss, but it also reduces the chances of a person developing other weight-related medical conditions such as sleep apnea, hypertension, high cholesterol levels, and more importantly cardiovascular diseases.

Are you a candidate for Gastric Sleeve or Balloon:

The best candidates for intragastric balloons are patients who have the following features:

• Patients with a BMI of less than 40 kg/m² (30 to 40 kg/m²)
• The person does not have more than two obesity-associated complications
• As a bridge therapy for super obese patients
• Individuals who have failed to lose weight with diet, behavioral therapy, and exercise
• Severely obese patients who can not walk around or exercise.
• Individuals who do not want surgery or can not undergo a surgical procedure.
• People who are willing to follow the recommended diet and perform physical activity.
• Adults with a minimum age of 18 years.

The best candidates for sleeve gastrectomy are:

• Patients with a BMI of more than 35Kg/m²
• People who have failed nutritional and behavioral therapy
• Those with multiple obesity-associated complications.

How much weight loss should you expect with Gastric Balloon Vs Gastric Sleeve Surgery?

Gastric balloon:

Intragastric balloons work on the principal space-occupying devices. In this procedure, only the limitation of the food reservoir is in play. Currently, FDA-approved devices are for 6 months of use only after that do these have to be removed.

Studies suggest that there is a significant amount of weight loss in the first 6 months after placement. One meta-analysis did which showed that there was a 10.6% of mean total weight loss and excess weight loss of 29.65% in the first year.

Some studies suggest that you lose about 20% of your body weight. Weight loss is not noticeable immediately after the balloon is placed.

Especially in patients who opt for an Obalon Gastric balloon, patients may only start losing weight after the second or the third gastric balloon is placed.

Gastric Sleeve:

In patients undergoing sleeve gastrectomy, the amount of weight loss was significantly higher than intragastric balloon placement.

Typically, you’ll start losing weight @ one pound per day during the first two weeks. So, during the first two weeks, you’ll lose about 10 to 20 pounds in the first two weeks.

During the next 3 months, you are going to lose 30 to 45% of the excess weight and 50 to 60% during the first six months.

The average weight loss reported after one year is approximately 60 to 70%. It is after one to two years that people lose the maximum weight.

Laparoscopic sleeve gastrectomy has about a 90% success rate.

Which Procedure is Best for Long-term Weight Management?

The main limitation of intragastric balloons is that this procedure does not provide a long-term solution for weight loss.

After 18 to 24 months there was a significant reduction in the weight loss effect of intragastric balloons. Many patients had weight gain instead. Furthermore, this is a reversible procedure and can be reversed at any time when the patient opts out.

Sleeve gastrectomy is a procedure that provides long-term weight loss solutions with proper care and motivation.

The gastric sleeve is not reversible. Unlike a Gastric balloon, it provides better and long-term weight control.  People who undergo gastric sleeves usually do not regain weight easily.

Gastric Sleeve Vs Balloon: Which is Best for Diabetes?

One of the studies showed a mild decrease in HbA1c levels in patients undergoing gastric balloons. It showed their effect at 16 and 52 weeks. There was a slight decrease in HbA1c levels at 18 weeks (7%). Whereas in 52 weeks there was a decrease of 1%.

Sleeve gastrectomy is associated with better glycemic controls and amelioration in type 2 diabetes. 60% to 80% of the patients who undergo gastric sleeve achieve remission or improvement in their diabetes.

Gastric Sleeve Vs Balloon for other weight-related conditions:

For the intragastric balloons system, not many studies are done that show the resolution of co-morbid conditions related to obesity.

Sleeve gastrectomy shows better resolution of co-morbid related to obesity. Patients who undergo gastric sleeves have noticed an improvement in the following obesity-related complications:

Although LSG or gastric sleeve has a significant effect on weight-related complications, most insurance companies cover LSG only if:

• The BMI is 40 kg/m² or more
• The BMI is 35 to 40 kg/m² plus any of the following obesity-associated medical conditions:
  • Hypertension
  • Diabetes
  • Hyperlipidemia
  • Sleep apnea, and
  • Fatty liver

Gastric Sleeve Vs Balloon: Which Procedure is Safe?

The intra-gastric balloon is much safer than sleeve gastrectomy. As this procedure is less invasive and has the least complication than sleeve gastrectomy.

Apart from the per-operative complications and anesthesia-related complications of laparoscopic sleeve gastrectomy, it is also associated with greater immediate post-operative complications.

The long-term complications of both procedures are as follows:

Complications of the intragastric balloons system

• GERD
• Nause and vomiting (initially)
• Small gut obstruction
• Perforation

Sleeve gastrectomy complications

• Port site infection
• Leakage from the anastomosis site
• Port site herniation
• Bleeding

Will you tolerate Gastric Sleeve or Intragastric Balloon better?

Both procedures are usually better tolerated. However, some patients are not able to tolerate gastric balloons because the balloon is a foreign body. These patients usually opt for the removal of the balloon.

Sleeve gastrectomy is better tolerated as it is done under GA (general anesthesia) and has no physical foreign body in the stomach.

Patients have normal feelings other than being full all the time. These patients have a normal life especially after a few months and with proper dietary counseling.

Table Summarizing the Pros and Cons of Gastric Sleeve Vs Balloon: