Obesity Surgery

, 17:649 | Cite as

Intragastric Balloon-Induced Satiety is Not Mediated by Modification in Fasting or Postprandial Plasma Ghrelin Levels in Morbid Obesity

  • Maria Asuncion Martinez-Brocca
  • Ovidio Belda
  • Juana Parejo
  • Luis Jimenez
  • Agustin del Valle
  • Jose Luis Pereira
  • Felipe Garcia-Pesquera
  • Ricardo Astorga
  • Alfonso Leal-Cerro
  • Pedro Pablo Garcia-Luna


The BioEnterics Intragastric Balloon (BIB) has been proposed as an adjuvant therapy for the short-term treatment of obesity. The temporal pattern of BIB-induced satiety and whether this effect is mediated by modification of ghrelin levels is unknown.


Patients with treatment-resistant morbid obesity were invited to participate in a randomized, double-blind, sham-controlled trial of 4-month duration. Anthropometric and biochemical parameters, estimation of energy intake, and pre- and postprandial evaluation of satiety were required monthly. Ghrelin response after a standard mixed meal was scheduled prior to and 4 weeks after the endoscopic procedure.


21 out of 22 enrolled patients completed the study (17 women, 5 men; 35.9 ±–.9 years; BMI 50.4 ±–.8 kg/m2). Pre-intervention weight decreased from 143.8 ±–1.2 kg to 131.1 ±–2.6 kg in Group Balloon (P–lt;–.001) and from 138.8 ±–4.5 kg to 129.9 ±–5.6 kg in Group Sham (P–lt;–.01) at the end of the study. Weight loss was not significantly different in Group Balloon and Group Sham at any time-point of the follow-up. Only patients from Group Balloon showed a temporary increased pre- and postprandial satiety, which was maximal at 4 weeks after the intervention. Total area under the curve, fasting and postprandial plasma ghrelin were not significantly different between groups at inclusion or 4 weeks after follow-up. No correlation was found between any of the satiety scores at any time-point with their comparable ghrelin levels.


BIB induces a temporary sense of satiety in morbidly obese patients which is not mediated by modification of fasting or postprandial levels of plasma ghrelin.

Key words

Morbid obesity intragastric balloon satiety ghrelin bariatric surgery 


  1. 1.
    Bray GA, Tartaglia LA. Medicinal strategies in the treatment of obesity. Nature 2000; 404: 672–.PubMedGoogle Scholar
  2. 2.
    Pereira Cunill JL, Garcia-Luna PP, Astorga Jimenez R. Pros and cons of surgery in obesity. Rev Clin Esp 2003; 203: 567–.CrossRefPubMedGoogle Scholar
  3. 3.
    Totte E, Hendrickx L, Pauwels M et al. Weight reduction by means of intragastric device: experience with the bioenterics intragastric balloon. Obes Surg 2001; 11: 519–3.CrossRefPubMedGoogle Scholar
  4. 4.
    Doldi SB, Micheletto G, Perrini MN et al. Treatment of morbid obesity with intragastric balloon in association with diet. Obes Surg 2002; 12: 583–.CrossRefPubMedGoogle Scholar
  5. 5.
    Loffredo A, Cappuccio M, De Luca M et al. Three years experience with the new intragastric balloon, and a preoperative test for success with restrictive surgery. Obes Surg 2001; 11: 330–.CrossRefPubMedGoogle Scholar
  6. 6.
    Sallet JA, Marchesini JB, Paiva DS et al. Brazilian multicenter study of the intragastric balloon. Obes Surg 2004; 14: 991–.CrossRefPubMedGoogle Scholar
  7. 7.
    Genco A, Bruni T, Doldi SB et al. BioEnterics Intragastric Balloon: The Italian experience with 2,515 patients. Obes Surg 2005; 15: 1161–.CrossRefPubMedGoogle Scholar
  8. 8.
    Weiner R, Gutberlet H, Bockhorn H. Preparation of extremely obese patients for laparoscopic gastric banding by gastric-balloon therapy. Obes Surg 1999; 9: 261–.CrossRefPubMedGoogle Scholar
  9. 9.
    Busetto L, Segato G, De Luca M et al. Preoperative weight loss by intragastric balloon in super-obese patients treated with laparoscopic gastric banding: a case-control study. Obes Surg 2004; 14: 671–.CrossRefPubMedGoogle Scholar
  10. 10.
    Alfalah H, Philippe B, Ghazal F et al. Intragastric balloon for preoperative weight reduction in candidates for laparoscopic gastric bypass with massive obesity. Obes Surg 2006; 16: 147–0.CrossRefPubMedGoogle Scholar
  11. 11.
    Kojima M, Hosoda H, Date Y et al. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature 1999; 402: 656–0.CrossRefPubMedGoogle Scholar
  12. 12.
    Nakazato M, Murakami N, Date Y et al. A role for ghrelin in the central regulation of feeding. Nature 2001;409:194–.CrossRefPubMedGoogle Scholar
  13. 13.
    Tschop M, Smiley DL, Heiman ML. Ghrelin induces adiposity in rodents. Nature 2000; 407: 908–3.CrossRefPubMedGoogle Scholar
  14. 14.
    Cummings DE, Purnell JQ, Frayo RS et al. A preprandial rise in plasma ghrelin levels suggests a role in initiation in humans. Diabetes 2001; 50: 1714–.CrossRefPubMedGoogle Scholar
  15. 15.
    Tschop M, Weyer C, Tataranni PA et al. Circulating ghrelin levels are decreased in human obesity. Diabetes 2001; 50: 707–.CrossRefPubMedGoogle Scholar
  16. 16.
    Cummings D, Weigle D, Frayo S et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med 2002; 346: 1623–2.CrossRefPubMedGoogle Scholar
  17. 17.
    Le Roux CW, Patterson M, Vincent RP et al. Postprandial plasma ghrelin is suppressed proportional to meal calorie content in normal-weight but not obese subjects. J Clin Endocrinol Metab 2005; 90: 1068–1.CrossRefPubMedGoogle Scholar
  18. 18.
    Gastrointestinal surgery for severe obesity. National Institutes of Health Consensus Development Conference Draft Statement. Obes Surg 1991; 1: 257–5.Google Scholar
  19. 19.
    SEEDO–000 consensus for the evaluation of overweight and obesity and the establishment of criteria for therapeutic intervention. Sociedad Espanola para el Estudio de la Obesidad. Med Clin (Barc) 2000; 115: 587–7.Google Scholar
  20. 20.
    Romero H, Martinez-Brocca MA, Pereira JL, Garcia-Luna PP. Pharmacological treatment of obesity. Rev Esp Obes 2005; 3: 13–5.Google Scholar
  21. 21.
    Suerbaum S, Michetti P. Medical progress: Helicobacter pylori infection. N Engl J Med 2002; 347: 1175–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Executive summary of the Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486–7.Google Scholar
  23. 23.
    Benjamin SB, Maher KA, Cattau EL et al. A doubleblind controlled trial of the Garren-Edwards gastric bubble: an adjunctive treatment for exogenous obesity. Gastroenterol 1988; 95: 581–.Google Scholar
  24. 24.
    Meshkinpour H, Hsu D, Farivar S. Effect of gastric bubble as a weight reduction device: a controlled crossover study. Gastroenterol 1988; 95: 589–2.Google Scholar
  25. 25.
    Mathus-Vliegen EMH, Tytgat GNJ. Intragastric balloons for morbid obesity: results, patient tolerance and balloon life span. Br J Surg 1990; 77: 76–.CrossRefPubMedGoogle Scholar
  26. 26.
    Geliebter A, Melton PM, McCray RS et al. Clinical trial of silicone-rubber gastric balloon to treat obesity. Int J Obes 1991; 15: 259–6.PubMedGoogle Scholar
  27. 27.
    Hodson RM, Zacharoulis D, Goutzamani E et al. Managment of obesity with the new intragastric balloon. Obes Surg 2001; 11: 327–.CrossRefPubMedGoogle Scholar
  28. 28.
    Erdman J, Lippl F, Schusdziarra V. Differential effect of protein and fat on plasma ghrelin levels in man. Regul Pept 2003; 116: 101–.CrossRefGoogle Scholar
  29. 29.
    Mion F, Napoleon B, Roman S et al. Effects of intragastric balloon on gastric emptying and plasma ghrelin levels in non-morbid obese patients. Obes Surg 2005; 15: 510–.CrossRefPubMedGoogle Scholar
  30. 30.
    Herve J, Wahlen CH, Schaeken A et al. What becomes of patients one year after the intragastric balloon has been removed? Obes Surg 2005; 15: 864–0.CrossRefPubMedGoogle Scholar
  31. 31.
    Doldi SB, Micheletto G, Perrini MN et al. Intragastric balloon: another option for treatment of obesity and morbid obesity. Hepatogastroenterology 2004; 51: 294–.PubMedGoogle Scholar
  32. 32.
    Mathus-Vliegen EMH, 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;61:19–7.CrossRefPubMedGoogle Scholar
  33. 33.
    Genco A, Cipriano M, Bacci V et al. BioEnterics® Intragastric Balloon: a short-term, double-blind, randomised, controlled, crossover study on weight reduction in morbidly obese patients. Int J Obes 2006; 30: 129–3.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • Maria Asuncion Martinez-Brocca
    • 1
  • Ovidio Belda
    • 2
  • Juana Parejo
    • 1
  • Luis Jimenez
    • 3
  • Agustin del Valle
    • 4
  • Jose Luis Pereira
    • 1
  • Felipe Garcia-Pesquera
    • 5
  • Ricardo Astorga
    • 1
  • Alfonso Leal-Cerro
    • 1
  • Pedro Pablo Garcia-Luna
    • 1
    • 6
  1. 1.Department of Endocrinology and NutritionUniversity Hospital Virgen del RocioSevilleSpain
  2. 2.Department of GastroenterologyUniversity Hospital Virgen del RocioSevilleSpain
  3. 3.Department of Clinical BiochemistryUniversity Hospital Virgen del RocioSevilleSpain
  4. 4.Section of Endocrine Surgery, Department of SurgeryUniversity Hospital Virgen del RocioSevilleSpain
  5. 5.Department of Nuclear MedicineUniversity Hospital Virgen del RocioSevilleSpain
  6. 6.Section of Clinical Nutrition. Department of Endocrinology and NutritionHospital Universitario Virgen del RocioSevilleSpain

Personalised recommendations