Intragastric balloon therapy for weight loss
- Ram Chuttani, MD
Ram Chuttani, MD
- Director of Endoscopy and
- Chief, Interventional Gastroenterology
- Beth Israel Deaconess Medical Center
- Harvard Medical School
More than 1.4 billion adults worldwide are overweight or obese. Obese individuals often develop health conditions such as diabetes, hypertension, and heart disease. A modest weight loss of 5 to 10 percent may be sufficient to delay or prevent the onset of diabetes and other obesity-related illnesses [1-3].
However, the availability of safe and effective weight loss therapies is limited. While bariatric surgery has proven efficacy in treating morbidly obese patients, it is not widely used in the moderately obese population due to its invasiveness, cost, and potentially lifelong side effects .
Intragastric balloon therapy is a minimally invasive, temporary method of inducing weight loss. It relies upon a soft, saline-filled balloon placed in the stomach to promote the feeling of satiety and restriction (figure 1). The weight loss mechanism of intragastric balloon therapy is restrictive. Any balloon with a volume of 400 mL or greater can induce satiety . Another possible mechanism of action that may also contribute to weight loss is by delaying gastric emptying [6,7]. The patient’s compliance with lifestyle modifications is essential for achieving and sustaining weight loss during and after therapy.
The indications for intragastric balloon therapy, the choices of available balloons, potential adverse effects, and strategies of maintaining weight loss after balloon removal are discussed in this topic. Other methods of achieving weight loss are discussed separately. (See "Obesity in adults: Overview of management" and "Bariatric procedures for the management of severe obesity: Descriptions".)
The initial management of obesity is with lifestyle intervention. All patients who would benefit from weight loss should receive counseling on diet, exercise, and goals for weight loss. (See "Obesity in adults: Overview of management".)
- Lau DC, Teoh H. Benefits of modest weight loss on the management of type 2 diabetes mellitus. Can J Diabetes 2013; 37:128.
- National Institute for Health and Care Excellence. Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. 2006.
- Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894:i.
- Mathus-Vliegen EM. Endoscopic treatment: the past, the present and the future. Best Pract Res Clin Gastroenterol 2014; 28:685.
- Geliebter A. Gastric distension and gastric capacity in relation to food intake in humans. Physiol Behav 1988; 44:665.
- Bonazzi P, Petrelli MD, Lorenzini I, et al. Gastric emptying and intragastric balloon in obese patients. Eur Rev Med Pharmacol Sci 2005; 9:15.
- Su HJ, Kao CH, Chen WC, et al. Effect of intragastric balloon on gastric emptying time in humans for weight control. Clin Nucl Med 2013; 38:863.
- Martins Fernandes FA Jr, Carvalho GL, Lima DL, et al. Intragastric Balloon for Overweight Patients. JSLS 2016; 20.
- Stanford FC, Kyle TK, Claridy MD, et al. The influence of an individual's weight perception on the acceptance of bariatric surgery. Obesity (Silver Spring) 2015; 23:277.
- Göttig S, Weiner RA, Daskalakis M. Preoperative weight reduction using the intragastric balloon. Obes Facts 2009; 2 Suppl 1:20.
- Dumonceau JM. Evidence-based review of the Bioenterics intragastric balloon for weight loss. Obes Surg 2008; 18:1611.
- http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm457416.htm (Accessed on February 24, 2016).
- http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm456296.htm (Accessed on September 10, 2015).
- Machytka E, Chuttani R, Bojkova M, et al. Elipse™, a Procedureless Gastric Balloon for Weight Loss: a Proof-of-Concept Pilot Study. Obes Surg 2016; 26:512.
- Moura D, Oliveira J, De Moura EG, et al. Effectiveness of intragastric balloon for obesity: A systematic review and meta-analysis based on randomized control trials. Surg Obes Relat Dis 2016; 12:420.
- Genco A, Cipriano M, Bacci V, et al. BioEnterics Intragastric Balloon (BIB): a short-term, double-blind, randomised, controlled, crossover study on weight reduction in morbidly obese patients. Int J Obes (Lond) 2006; 30:129.
- Fuller NR, Pearson S, Lau NS, et al. An intragastric balloon in the treatment of obese individuals with metabolic syndrome: a randomized controlled study. Obesity (Silver Spring) 2013; 21:1561.
- ASGE Bariatric Endoscopy Task Force and ASGE Technology Committee, Abu Dayyeh BK, Kumar N, et al. ASGE Bariatric Endoscopy Task Force systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting endoscopic bariatric therapies. Gastrointest Endosc 2015; 82:425.
- Kotzampassi K, Grosomanidis V, Papakostas P, et al. 500 intragastric balloons: what happens 5 years thereafter? Obes Surg 2012; 22:896.
- Ponce J, Woodman G, Swain J, et al. The REDUCE pivotal trial: a prospective, randomized controlled pivotal trial of a dual intragastric balloon for the treatment of obesity. Surg Obes Relat Dis 2015; 11:874.
- Lopez-Nava G, Bautista-Castaño I, Jimenez-Baños A, Fernandez-Corbelle JP. Dual Intragastric Balloon: Single Ambulatory Center Spanish Experience with 60 Patients in Endoscopic Weight Loss Management. Obes Surg 2015; 25:2263.
- Brooks J, Srivastava ED, Mathus-Vliegen EM. One-year adjustable intragastric balloons: results in 73 consecutive patients in the U.K. Obes Surg 2014; 24:813.
- Machytka E, Klvana P, Kornbluth A, et al. Adjustable intragastric balloons: a 12-month pilot trial in endoscopic weight loss management. Obes Surg 2011; 21:1499.
- Forlano R, Ippolito AM, Iacobellis A, et al. Effect of the BioEnterics intragastric balloon on weight, insulin resistance, and liver steatosis in obese patients. Gastrointest Endosc 2010; 71:927.
- Crea N, Pata G, Della Casa D, et al. Improvement of metabolic syndrome following intragastric balloon: 1 year follow-up analysis. Obes Surg 2009; 19:1084.
- Mui WL, Ng EK, Tsung BY, et al. Impact on obesity-related illnesses and quality of life following intragastric balloon. Obes Surg 2010; 20:1128.
- ASGE/ASMBS Task Force on Endoscopic Bariatric Therapy. A pathway to endoscopic bariatric therapies. Surg Obes Relat Dis 2011; 7:672.
- Goyal D, Watson RR. Endoscopic Bariatric Therapies. Curr Gastroenterol Rep 2016; 18:26.
- PMA P140008: FDA Summary of Safety and Effectiveness Data. http://www.accessdata.fda.gov/cdrh_docs/pdf14/P140008b.pdf (Accessed on January 25, 2016).
- PMA P140012: FDA Summary of Safety and Effectiveness Data. http://www.accessdata.fda.gov/cdrh_docs/pdf14/P140012b.pdf (Accessed on January 25, 2016).
- Imaz I, Martínez-Cervell C, García-Alvarez EE, et al. Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis. Obes Surg 2008; 18:841.
- Gaur S, Levy S, Mathus-Vliegen L, Chuttani R. Balancing risk and reward: a critical review of the intragastric balloon for weight loss. Gastrointest Endosc 2015; 81:1330.
- Yap Kannan R, Nutt MR. Are intra-gastric adjustable balloon system safe? A case series. Int J Surg Case Rep 2013; 4:936.
- Roman S, Napoléon B, Mion F, et al. Intragastric balloon for "non-morbid" obesity: a retrospective evaluation of tolerance and efficacy. Obes Surg 2004; 14:539.
- Genco A, Bruni T, Doldi SB, et al. BioEnterics Intragastric Balloon: The Italian Experience with 2,515 Patients. Obes Surg 2005; 15:1161.
- Farina MG, Baratta R, Nigro A, et al. Intragastric balloon in association with lifestyle and/or pharmacotherapy in the long-term management of obesity. Obes Surg 2012; 22:565.
- Alfredo G, Roberta M, Massimiliano C, et al. Long-term multiple intragastric balloon treatment--a new strategy to treat morbid obese patients refusing surgery: prospective 6-year follow-up study. Surg Obes Relat Dis 2014; 10:307.
- Genco A, Cipriano M, Bacci V, et al. Intragastric balloon followed by diet vs intragastric balloon followed by another balloon: a prospective study on 100 patients. Obes Surg 2010; 20:1496.
- Genco A, Lorenzo M, Baglio G, et al. Does the intragastric balloon have a predictive role in subsequent LAP-BAND(®) surgery? Italian multicenter study results at 5-year follow-up. Surg Obes Relat Dis 2014; 10:474.
- TYPES OF INTRAGASTRIC BALLOONS
- EFFICACY OF INTRAGASTRIC BALLOONS
- Weight loss
- - Orbera
- - ReShape
- - Spatz
- Improvement in metabolic parameters
- - Orbera
- - ReShape
- COMPARISON WITH OTHER WEIGHT LOSS THERAPIES
- Medical therapies
- Surgical therapies
- ADVERSE EVENTS
- Common adverse events
- Serious adverse events
- - Balloon-related serious adverse events
- - Procedure-related serious adverse events
- ADDITIONAL TREATMENT AFTER INTRAGASTRIC BALLOON THERAPY
- Repeat balloon therapy
- Adjustable balloon system
- Bariatric surgery
- SUMMARY AND RECOMMENDATIONS