Non-surgical weight loss: Dr Ganesh’s guide to gastric balloons in Singapore (2021)

Obesity is a problem that plagues Singapore due to our dietary habits and sedentary lifestyle, putting us at risk of high blood pressure, cardiovascular diseases and diabetes. Eating in a caloric deficit and exercising can help us to shed some weight, but what if you’ve tried them all and nothing seems to work? Well, you might want to consider medical intervention to help you, such as through the use of bariatric surgery or gastric balloons. 

Learn about an obese, diabetic teen’s journey in surgical weight loss

Typically, weight loss surgery is offered if the individual has a BMI of at least 32.5 and has serious weight-related health issues. But surgery may not be suitable for everyone — gastric balloons are a great non-surgical approach to weight loss and do not alter the anatomy of the stomach. Let’s find out more. 

What are gastric balloons?

Gastric balloons are an effective weight loss method in Singapore that does not require surgery. It involves placing a gastric balloon in the stomach, which is then filled so that it takes up space in the stomach, thereby limiting the capacity of the stomach to absorb food and achieve weight loss. 

What are the types of gastric balloons in Singapore? 

Traditional Intragastric Balloons

Traditional intragastric balloons require endoscopy and sedation. In this process, the doctor inserts a catheter tube with the gastric balloon down into your stomach, and then inserts an endoscope (with a camera attached) down your throat so that they can view the balloon while filling it with saline. After about 6 months, the balloon will be removed with an endoscope. 

Elipse Balloon

The new Elipse balloon by Allurion Technologies can do the same without surgery, endoscopy or anaesthesia. It is an ingestible gastric balloon. The deflated balloon is inside a capsule attached to a catheter. The capsule is swallowed with water, and an X-ray is performed to confirm that the capsule is in the stomach. Then, the balloon will be filled up via the catheter. After filling the balloon, another X-ray will be taken to ensure the balloon has been properly inflated. Then, the catheter tube will be detached from the balloon and the procedure is complete. 

After about 16 weeks, a time-activated release valve opens and allows the balloon to empty and be passed out by the digestive system naturally. The Elipse gastric balloon is highly preferred by patients as it is the only gastric balloon that does not require an endoscopy for insertion and removal, and can be swallowed just like a regular pill! 

Currently, only a few clinics in Singapore (including mine) offer the Elipse gastric balloon. 

Read more about the differences between an Allurion Elipse Balloon v.s. Gastric Balloons

An illustration of a gastric balloon

Should I get a gastric balloon or bariatric surgery for weight loss? 

Who is suitable for gastric balloons? 

You may be a suitable candidate for gastric balloons if other methods of losing weight have failed, such as dieting or exercising. You should also have a Body Mass Index (BMI) between 30 and 40, which is lower than what is required for bariatric surgery. Hence, you may opt for gastric balloons if your BMI is high but not high enough to qualify you for bariatric surgery in Singapore. 

Having one or more weight-related health issues such as type 2 diabetes, high blood pressure, fatty liver disease or sleep apnea, would also qualify you for gastric balloons. 

However, if you have had bariatric or gastrointestinal surgery in the past, or if you have an inflammatory disease of the gastrointestinal tract, then we do not recommend you to do the gastric balloon procedure. Other gastrointestinal conditions such as gastric mass, hiatal hernia or liver failure would also mean that you are not suited for gastric balloons. 

Who is suitable for bariatric surgery?

Similarly, if other methods of weight loss have not worked for you, bariatric surgery might be a viable option. Your BMI should be 40 or higher and you must be between the age of 18 – 65 to qualify for bariatric surgery in Singapore. 

If your BMI is 35 and you have at least one health problem related to obesity, such astype 2 diabetes, hypertension, fatty liver disease or sleep apnea, then you also qualify for bariatric surgery. 

Bariatric surgery requires you to be in a strong enough physical condition to handle the surgery and not have any other severe medical issues that could complicate surgery. It is not advised for patients who are pregnant or are planning to become pregnant. Talk to your doctor if you are considering bariatric surgery and they will let you know if this is a safe option for you. 

Is the Elipse balloon safe?

A study on 1770 Elipse patients to determine the safety and efficacy of the Elipse balloon showed that the Elipse balloon was easily swallowed with only 1 patient unable to swallow the capsule. 35.9% of the patients required assistance when swallowing. 

The Elipse balloon was well tolerated. Side effects of nausea and vomiting were well-controlled with medication. Patients who showed intolerance and had to remove the balloon were at a low percentage of 2.9%. Also, 95.6% of the balloons were safely exited from the gastrointestinal tract. Eleven empty balloons were vomited at the end point without any adverse events. 

There were 3 small bowel obstructions that were managed with laparoscopy, but these adverse events are rare, and happened with the earlier generation of the Elipse balloon. After some modifications, the new generation of Elipse balloons did not report any small bowel obstructions in 635 patients after the year 2018. 

Similarly, the problem of spontaneous hyperinflation that warranted endoscopic removal in 4 patients was mitigated by a manufacturing change to the filling liquid, and there were no further incidents thereafter. 

Moreover, efficacy-wise, Elipse balloons showed remarkable results of 14.2 percent total body weight loss (TBWL) and improvement in all metabolic parameters. 

The Elipse balloon has shown to be safe with limited side effects that can be easily resolved and complications that are few and far between. It is a proven and effective method for weight loss.

What are the side effects and complications of the Elipse balloon? 

There are some side effects of the Elipse balloon that you should know about. These are a consequence of the body’s natural defence mechanism because it treats the balloon as a foreign object in the stomach. They tend to last only about 3 – 4 days before subsiding when the body has gotten used to it. 

Some side effects of the Elipse balloon includes: 

Nausea 

This sensation is similar to sea-sickness. The doctor may provide you with medication to help with nausea. 

Vomiting 

The nausea medication will help with vomiting, but the doctor will also provide you with some tips to remain hydrated until the vomiting subsides after a day or so. 

Stomach cramps 

Some patients may experience cramping which is uncomfortable but short-lived and will improve when the stomach gets used to the presence of the balloon. 

Some complications that are rare but may be caused by the Elipse balloon includes: 

Intolerance 

In a small subset of patients, they may be unable to tolerate the side effects of the balloon and need to have it removed. For those who struggle with the gastric balloon, we can try medication and hydration to cope with the symptoms, with surgical removal being the last resort when all else fails. 

Rupture 

Bursting of the balloon inside the stomach is a concern for many patients. While it is a possibility, the chances of it happening is very small. We do have an added precaution – a harmless blue methylene dye is added when filling the balloon, so that if your urine turns green, it would signal a rupture and a removal procedure can be arranged. 

The gastric balloon is the safest procedure out of all weight loss management options with the lowest risk of complications. As it is non-surgical, there are no incisions, no scars that require healing and no internal changes to your digestive system, making it one of the best choices out there. 

What are the benefits of the Elipse balloon?

Here are some reasons why you should opt for the Elipse balloon: 

  • No surgery 
  • No endoscopy except when rare complications arise
  • No anaesthesia
  • Shortened discharge time 
  • Fast recovery 
  • Effective weight loss outcome

Read more about the pros and cons of the Elipse balloon.

What can you eat or drink when you have an Elipse balloon? 

You will be required to stick to a customised plan recommended by your nutritionist, complete with exercise and behaviour modification. 

For the first three days, you should only have about 8 cups of liquid each day. Solid foods are a strict no-no. These liquids can be: 

  • Skimmed milk 
  • Herbal teas 
  • Diluted low sugar fruit juices 
  • Clear beef or chicken broth 

From days 4 – 7, you may eat softer foods such as: 

  • Yoghurt 
  • Porridge 
  • Thicker soups like cream of mushroom soup 
  • Mashed potatoes 
  • Blended foods like fish, lean meats, fibrous fruits and vegetables

You should also continue to take small sips of about 8 cups of caffeine-free, low-calorie liquids to prevent dehydration.

From day 10 onwards, your appetite should return and you may resume eating normal but healthy foods. 

Some foods that you should avoid include: 

  • Tough and fibrous food 
  • Soft, doughy bread 
  • Overcooked rice and pasta 
  • Hard vegetables and fruits 
  • Lettuce 
  • Skins and small seeds
  • Foods rich in fat like pies, pastry, cheese, cream, coffee and alcohol 
  • Strongly flavoured foods like curries 

How much does the Elipse balloon cost in Singapore?

The cost of an Elipse balloon in Singapore is about several thousand dollars, depending on the clinic you go to. 

I recommend going to a clinic that offers both the gastric balloon and bariatric surgery, just to make sure the clinic doesn’t push the option they offer and you can weigh your options accordingly. 

Conclusion

With all the perks of a gastric balloon, I think you’ll find them an optimal complement to your weight loss journey. Remember that strict adherence to diet and exercise is still necessary with the gastric balloon; it is not a shortcut to help you magically lose weight. If you’re still not sure, consult your doctor and they will advise you on whether bariatric surgery or a gastric balloon would work better given your situation. Either way, I’m sure you’ll lighten up with these safe and effective weight loss methods.

References

  1. Stahl, J. M., & Malhotra, S. (2020). Obesity surgery indications and contraindications. StatPearls [Internet]
  2. Al-Subaie, S., Khalifa, S., Buhaimed, W., & Al-Rashidi, S. (2017). A prospective pilot study of the efficacy and safety of Elipse intragastric balloon: a single-center, single-surgeon experience. International Journal of Surgery, 48, 16-22. 
  3. Ienca, R., Al Jarallah, M., Caballero, A., Giardiello, C., Rosa, M., Kolmer, S., … & Al Kuwari, M. (2020). The procedureless elipse gastric balloon Program: multicenter experience in 1770 consecutive patients. Obesity surgery, 30(9), 3354-3362.

This article was written and medically reviewed by Dr. Ganesh Ramalingam, M.D.