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Intragastric Balloon Treatment for Obesity

A new intragastric balloon holds promise for achieving weight loss in obese patients.

Bariatric surgery is increasingly used to facilitate weight loss in morbidly obese patients. Endoscopic placement of an intragastric balloon (i.e., Garron-Edwards Gastric Bubble) was discontinued in 1987 because of a high complication rate. Investigators in the Netherlands evaluated a new intragastric balloon (volume range, 400-800 mL) designed to avoid the complications of earlier intragastric balloons.

Researchers randomized 43 treatment-resistant obese patients (body-mass index 32 kg/m²) to receive intragastric balloon (20 patients) or sham (23) treatment. All patients received dietary and behavioral therapy. Patients in both groups who achieved a predetermined weight loss goal of 6.5 kg after 3 months received balloon treatment for an additional 9 months (balloon replaced every 3 months). Patients were followed for 1 year after balloon removal.

Mean weight loss was similar in the balloon and sham groups during the first 3 months (10.4% and 9.0% of initial body weight, respectively). After 1 year of treatment, mean weight loss among the 12 patients (60%) remaining in the balloon-balloon group and 21 patients (91%) in the sham-balloon group was similar (21.3 kg or 17.1%). At the end of the follow-up year after balloon therapy, mean weight loss was 12.6 kg (9.9%). Nearly half of the 33 patients who completed the study had sustained weight loss of 10% or greater after 2 years. Complications of balloon placement occurred in 2 patients (1.6%), and spontaneous balloon deflation occurred in 3 patients (2.3%). The authors concluded that intragastric balloon therapy is associated with significant weight loss, much of which is maintained 1 year after balloon removal.

Comment: Various endoscopic bariatric procedures are being developed. The results of this modification of a previous methodology are promising for achieving short-term and sustained weight loss in obese patients. It is not possible, however, to determine the independent role of the intervention because the study lacked a true control group without balloon therapy and because all patients had dietary and behavioral therapy. Notably, about 25% of patients did not complete the protocol. The small number of patients also precludes making a meaningful estimate of potential complications associated with widespread use of the intervention. Larger studies with a true control group are needed to determine the potential role of intragastric balloon therapy for obesity.

— David J. Bjorkman, MD, MSPH, SM (Epid.)

Published in Journal Watch Gastroenterology March 1, 2005

Citation(s):

Mathus-Vliegen EM and Tytgat GNJ. Intragastric balloon for treatment-resistant obesity: Safety, tolerance, and efficacy of 1-year balloon treatment followed by a 1-year balloon-free follow-up. Gastrointest Endosc 2005 Jan; 61:19-27.

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