The incessant increase of obesity in the world and the natural evolution of science aiming at solving our patients’ problems and based on two fundaments—safety and lesser trauma, minimizing risks in the treatment of this disease—were decisive factors to make us seek a new alternative technique, the intragastric balloon. We took into consideration the innumerous patients with morbid obesity, the high rates of increase in weight with its associated diseases, the threats to their lives, and, in the case of surgery, the anguish caused to the patients themselves, doctors, and family members. In many cases, these patients would postpone surgeries, exposing themselves to an even greater risk: the excess weight itself with the limitations it imposes and its severe consequences; the interference in their quality of life and life expectancy.
The objective of this chapter is to report this method among our colleagues involved in the treatment of obesity, to establish multidisciplinary teams for both clinical and surgical treatment, as well as to inform the lay public and potential candidates about this technique. It is important to stress the selection criteria used to indicate this method of treatment to the patients. The target population consists of massively obese patients with severe associated illnesses (sleep apnea, DM, systemic arterial hypertension, etc.) in the preoperative period for bariatric, cardiovascular, orthopedic, abdominal surgery, or surgery in general. Another indication would be overweight individuals or patients with grade I obesity, who fail in well-oriented clinical treatment and suffer from or run the risk of developing associated diseases. It could also be a temporary option for morbid obesity patients who do not accept surgery or are not in good clinical condition for surgery. In this latter case, the procedure can in fact be repeated.
We would like to emphasize that the technical placement of the balloon is simple and can be performed by most endoscopists. What is essential for achieving good results is the preparation of a multidisciplinary team consisting of clinician, psychiatrist, psychologist, dietitian, and a physical activity professional.
As to correct and appropriate preparation of patients, the indications and limitations of the method should be made clear, thus avoiding unrealistic expectations. Likewise, it is important that patients comply with the treatment as a whole, understanding that the method “facilitates” following a hypocaloric diet and oriented physical activity.
The concept of the balloon was developed through observation of the effects naturally caused by bezoar (formation of large food bolus impairing gastric emptying) in weight loss. The presence of bezoar leads to weight loss and its removal results in recovering initial weight. The SIB (later BIB) was developed incorporating the positive aspect of weight loss induced by bezoar and adapting to its physiology and anatomy.