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The Effect of the Intra-gastric Balloon on Gastric Emptying and the DeMeester Score

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Abstract

Background and Aims

The mechanism of weight loss with the intra-gastric balloon (IGB) is thought to be a decrease in gastric emptying (GE); however the evidence is conflicting. Nausea, abdominal pain, and gastroesophageal reflux disease (GERD) can cause intolerance resulting in early removal. This is demoralizing for the patient and costly for the healthcare system. The ability to predict which patients will have superior weight loss and tolerance is invaluable. We sought to investigate if the IGB induced weight loss by reducing GE and the effect of the IGB on the DeMeester score.

Methods

We retrospectively reviewed prospectively collected data for patients undergoing IGB placement at a single hospital. Manometry and pH studies were performed before and with the IGB in place. Weight was measured at baseline, at removal, and 6 months later. Adverse events leading to early removal were recorded.

Results

Twenty-four patients were evaluated. There was a statistically significant decrease in GE for solids with the IGB (117.92 ± 150.23 vs 281.48 ± 206.49 min; p = 0.0048), but not for liquids (54.44 ± 17.97 vs 56.08 ± 43.96 min; p = 0.7228). The lower esophageal sphincter (LES) pressure did not change significantly with placement of the IGB (17.76 ± 7.39 vs 14.74 ± 7.24 mmHg; p = 0.09). On multivariate analysis, increase in DeMeester score was associated with total body weight loss (p = 0.0125) and change in GE (p = 0.038) independently.

Conclusion

The IGB delays GE for solids, but not for liquids, and increases the DeMeester score by a mechanism other than a loss of LES pressure.

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Abbreviations

IGB:

Intra-gastric balloon

GE:

Gastric emptying

GERD:

Gastroesophageal reflux disease

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Authors and Affiliations

  1. Division of Gastrointestinal Endoscopy, ABC Medical School, São Paulo, Brazil

    Sergio Barrichello, Manoel Galvão Neto, Robin Yance, Eduardo Grecco, Thiago Ferreira de Souza & Cynthia Teixeira

  2. Division of Bariatric Endoscopy, Healthme Clinic, São Paulo, Brazil

    Sergio Barrichello, Andre Veinert, Thiago Ferreira de Souza & Cynthia Teixeira

  3. Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Dilhana Badurdeen, Abdellah Hedjoudje, Lea Fayad, Cem Simsek, Anthony N. Kalloo, Mouen A. Khashab & Vivek Kumbhari

  4. Hospital das Clinicas da FMUSP, São Paulo, Brazil

    Gabriel Cairo Nunes

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  1. Sergio Barrichello
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Contributions

Sergio Barrichello: Provided the patient cohort; analysis and interpretation of data; critical revision.

Dilhana Badurdeen: Analysis and interpretation of data; critical revision

Abdellah Hedjoudje: Analysis and interpretation of data; critical revision

Manoel Galvão Neto: Analysis and interpretation of data; critical revision

Robin Yance: Analysis and interpretation of data; critical revision

Andre Veinert: Analysis and interpretation of data; critical revision

Lea Fayad, MD: Analysis and interpretation of data; critical revision

Cem Simsek, MD: Analysis and interpretation of data; critical revision

Eduardo Grecco: Analysis and interpretation of data; critical revision

Thiago Ferreira de Souza: Analysis and interpretation of data; critical revision

Cynthia Teixeira: Analysis and interpretation of data; critical revision

Gabriel Cairo Nunes: Analysis and interpretation of data; critical revision

Anthony N. Kalloo: Analysis and interpretation of data; critical revision

Mouen A. Khashab: Analysis and interpretation of data; critical revision

Vivek Kumbhari: Drafting of article analysis and interpretation of data; critical revision; final approval

Corresponding author

Correspondence to Vivek Kumbhari.

Ethics declarations

Ethical Approval

The ethics committee at the Hospital Estadual Mario Covas approved the IRB for the study.

Informed Consent

Informed consent does not apply.

Conflict of Interest

Anthony Kalloo is a founding Member, equity Holder and consultant for Apollo Endosurgery. Mouen A. Khashab is on the medical advisory board for Boston Scientific and Olympus America and is a consultant for Boston Scientific, Olympus America, and Medtronic. Vivek Kumbhari is a consultant for Medtronic, Reshape Lifesciences, Boston Scientific, Pentax Medical, and Apollo Endosurgery. He also receives research support from ERBE USA and Apollo Endosurgery. Manoel Galvão Neto is a consultant for Apollo Endosurgery and Ethicon endosurgery. Eduardo Grecco is a consultant for Apollo Endosurgery and Fractyl labs. Thiago Ferreira de Souza is a consultant for Apollo Endosurgery. All other authors declare that they have no conflict of interest.

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Sergio Barrichello and Dilhana Badurdeen are co first authors for this paper.

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Barrichello, S., Badurdeen, D., Hedjoudje, A. et al. The Effect of the Intra-gastric Balloon on Gastric Emptying and the DeMeester Score. OBES SURG 30, 38–45 (2020). https://doi.org/10.1007/s11695-019-04039-4

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  • DOI: https://doi.org/10.1007/s11695-019-04039-4

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