The Intragastric Balloon Bariatric Dietitians Musgrove Park Hospital TAUNTON Somerset TA1 5DA Tel. No. 01823 343394 September 2010 16
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NOTES: The Intragastric Balloon The intragastric balloon is a soft silicone balloon that is inserted into the stomach and inflated with saline through a self sealing valve. This is done via a tube which passes through your mouth and down into your stomach. It is a non surgical procedure which is performed under sedation or light anaesthetic How does the balloon work? The balloon partially fills the stomach which should lead to an increased feeling of fullness. Therefore it helps control portion size and, with an appropriate diet and behavioural modifications, lead to weight loss. How much weight will you lose? The balloon is a tool and the weight loss will depend largely on the changes you make to your diet. On average, people lose 1-2lbs (0.5-1kg) a week. The procedure explained The balloon is introduced through the mouth into the stomach. The doctor takes an initial look at the stomach, if no abnormalities are seen; they will then place the balloon. This is inserted in a small deflated form. The swallowing process is made easier with the help of anaesthetic spray applied to the area to numb the throat area. Once inside the stomach, it is immediately filled with 400-700ml of sterile solution through a small filling tube attached to the balloon. Once filled, the tube is gently removed by pulling on the external end; the balloon has a self sealing valve. 14 3
When the balloon is full it is too large to pass into the bowel and will now float freely inside the stomach. Placement times vary but it usually takes between 20-30minutes. Who is suitable for this procedure? The balloon is designed to assist with weight loss in people who are at least 40% above their ideal weight and who have been unable to achieve long-term weight loss through other means. It is not designed to be a permanent treatment for obesity. A bit about eating behaviour It will take you a while to get used to how the balloon feels being in place, and also to judge how much you can comfortably eat. You are changing some very ingrained behaviour so there will be occasions when you overeat or eat too fast. The trick is to learn from your experience and modify what and how you eat. You may have been eating in a certain way for many years and it s very difficult to change that overnight. Balloon removal This procedure is similar to the one you experienced when the balloon was placed and takes 20-30 minutes. You will be sedated. The clinician will remove the fluid from the balloon and then pull it out deflated. There are few after effects, however your doctor will keep you in for a couple of hours to allow the sedation to wear off. Important points: No solid food 24 hours before the procedure No liquids 12 hours before the procedure Due to the effects of the sedation, arrange for someone to drive you back home. Generally: Eat slowly Chew your food well When you are eating, concentrate on what you are doing The day before the balloon is inserted It is advised that you take no food for 12 hours before the balloon is placed. Remember to keep drinking fluids. 4 13
Points to note Eat slowly, chew well Aim to drink a 1½ litres (2 ¾ pints) of water in a day Don t eat and drink at the same time, leave half an hour before and after eating. It may be easier to sip on fluids through the day When you are eating solid foods again In order for you to lose weight with the balloon, you need to think of it as a tool to help you reassess and make changes to your eating habits. These issues will be discussed in more detail when you see the dietitian for your follow up appointments. The day of your operation Wear comfortable clothing and shoes You will be given a prescription for any medicines to be used after the procedure. These will include an anti-sickness tablet (Ondansetron) and Zoton, which decreases the acid in your stomach. The recommended dose of Zoton is 30mg per day; we recommend you split the dose to 15mg in the morning and 15mg in the evening. You will need someone to take you home as you may still be feeling the effects of the sedation after the procedure When advised to do so by the medical team, start sipping on cold fluids. Use a teaspoon to sip off or use a straw. Take your time with this; don t sip continually as you need to allow time for the fluid to leave your stomach. Slowly increase your quantity of fluids, don t gulp or drink quickly. Week 1 - Full fluid diet Initially you will have nausea and vomiting, because your stomach is contracting against the balloon in your stomach. It can feel like stomach flu. Ensure that you take the anti-sickness tablets given to you from the hospital. After a week you will start to feel a lot better. You may still feel some sickness, but generally this will be worse if you overeat. On the day after your operation, continue to have sips of water. If you find you tolerate these well then the next day start on the fluids listed below. This may take 2-3 days. It s important that you feel that you are managing the liquids before you move onto foods. 12 5
To test your response to thicker fluids you can try to sip 500mls of skimmed milk over 24 hours to assess if this makes you feel sick or nauseous. Fluids Low calorie, low acid fruit juices, such as apple and tropical juices (eg. mango rather than citrus juice). You may find you can tolerate all juices, the citrus ones may give you more indigestion Weak tea or coffee Clear broth or soup Low-calorie gelatins, eg. fruit jelly Low fat yogurt drinks Skimmed milk You may want to have meal replacement shakes in this week. Avoid Fizzy drinks Chocolate Ice cream Reflux Avoid eating late at night and wait at least 2 hours after eating before going to bed. The balloon tends to move up when you lie down and could cause reflux. If you have reflux in the evening, avoid coffee, tea and alcohol. Avoid smoking Raise your bed at the head end If you notice that certain foods make the symptoms worse, eg. tomatoes, pickles, oranges, then avoid these foods. Smelly breath This can be because food becomes trapped around the balloon. Try to drink water to help clear the balloon and stop the smell. Sucking on ice cubes 30 minutes after eating can also be effective. Exercising To help with your weight loss, try to incorporate some activity into your daily routine. You can start exercising as soon as you feel well after the balloon insertion. This is usually about two weeks after the procedure. 6 11
Going onto solid foods This is another transition stage so if you feel uncomfortable go back to the previous food that you tolerated. 1. Introduce solid foods one at a time. 2. Try cooked foods before you try hard/raw foods. 3. Limit bread, pasta, rice and other starches. These foods can stick to the balloon causing bad breath. 4. Drink plenty of water and avoid eating and drinking at the same time, drink at least one glass ½ hour before each meal and two glasses ½ hour after to rinse the balloon. Remember the 20/20 rule. Week 2 - Pureed, soft and solid foods Try not to rush this transition. If you are feeling that you aren t coping with the foods, go back to the previous consistency, then gradually work up the consistency again. Try to eat slowly, chewing your food well. Pureed foods (for up to 3 days) Once you are tolerating fluids well, you can start introducing pureed foods into your meals. In many cases you will be able to use the same foods as the rest of your family by blending with a food processor or hand blender. You should also try to incorporate protein into each meal (see examples below). Don t worry if you are unable to eat much. Stop if you feel discomfort or pressure. Meal ideas: Troubleshooting Vomiting In case of vomiting, stop eating for at least two hours, then drink a small amount of water and proceed with soft foods when tolerated. Aim to get back to solid foods. Try not to stay on soft foods too long as this will affect your weight loss. If the vomiting persists beyond 5-6 days, or you are unable to take oral fluids, you should contact your doctor in order to prevent dehydration. Breakfast 2-3 tablespoons instant oat cereal with skimmed milk or 1 very sloppy wheat biscuit type cereal or Yogurt Snack 200 mls/ grams pureed apple or pears or smoothie Lunch Blended mashed potato with melted cheese or Soup (not lumpy) Snack Yogurt or Skimmed milk (100mls) or Pot of custard 10 7
Main meal Try to include protein, starch and vegetables at each meal. Protein: Blended fine minced meat with gravy (200g) or Soft beans (preferably tinned) or lentils or Blended soft fish with white sauce (200g) and Starch: Blended mashed potato (100g) and Veg: Pureed carrots/swede Soft foods (for up to 4 days) Eat slowly and chew well. You should now be learning to listen to your body. Pay attention if you develop feelings of fullness, pressure or discomfort. These are signs that you should slow down or stop eating entirely in order to avoid vomiting. Breakfast 2-3 tablespoons porridge with skimmed milk or 1 very sloppy wheat biscuit type cereal or Yogurt Snack 200 mls/ grams pureed apple or pears or smoothie or Mashed banana Lunch Blended mashed potato (or soft potato mashed with a fork) with baked beans (mashed) or melted cheese or tinned tuna or Soup (not lumpy) or Crackers (chew to a mush) with soft cheese (eg. cottage cheese). 8 Snack Yogurt or Skimmed milk 100mls or Pot of custard Main meal Try to include protein, starch and vegetables at each meal. Protein: Fine minced meat (200g) or Soft beans (preferably tinned) or lentils or Soft fish with white sauce (200g) or tinned tuna or Soft egg and Starch: Mashed potato (100g) or Rice 30g and Veg: Pureed carrots/swede or Spinach or Other veg cooked until soft and mashable Other meal ideas: Cottage pie + soft vegetables or Fish pie + soft vegetables or Cauliflower cheese (not too much cheese) Remember the 20/20 rule when eating. Food should be chewed at least 20 times and a meal should take 20 minutes to eat 9