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Filling the Void: A Review of Intragastric Balloons for Obesity

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Abstract

Endoscopic bariatric therapies are predicted to become much more widely used in North America for obese patients who are not candidates for bariatric surgery. Of all the endoscopic bariatric therapies, intragastric balloons (IGBs) have the greatest amount of clinical experience and published data supporting their use. Three IGBs are FDA approved and are now commercially available in the USA (Orbera, ReShape Duo, and Obalon) with others likely soon to follow. They are generally indicated for patients whose BMI ranges from 30 to 40 mg/kg2 and who have failed to lose weight with diet and exercise. IGBs have been shown to be safe, effective, and relatively straightforward to place and remove. Accommodative symptoms commonly occur within the initial weeks post-placement; however, major complications are rare. Gastric ulceration can occur in up to 10% of patients, while balloon deflation with migration and bowel obstruction occurs in <1% of patients. The effectiveness of the Orbera and ReShape Duo IGBs ranges from 25 to 50% EWL (excess weight loss) after 6 months of therapy. The use of IGBs is likely to grow dramatically in the USA, and gastroenterologists and endoscopists should be familiar with their indications/contraindications, efficacy, placement/removal, and complications.

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References

  1. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: Payer-and service-specific estimates. Health Aff. 2009;28:w822–w831.

    Article  Google Scholar 

  2. Xu X, Bishop EE, Kennedy SM, Simpson SA, Pechacek T. Annual healthcare spending attributable to cigarette smoking: An update. Am J Prev Med. 2014;48:326–333.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Norris SL, Zhang X, Avenell A, Gregg E, Schmid CH, Lau J. Long-term non-pharmacological weight loss interventions for adults with prediabetes. Cochrane Database Syst Rev. 2005;18:CD005270.

    Google Scholar 

  4. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: A systematic and clinical review. JAMA. 2014;311:74–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23:427–436.

    Article  PubMed  Google Scholar 

  6. Hogan RB, Johnston JH, Long BW, et al. A double-blind, randomized, sham-controlled trial of the gastric bubble for obesity. Gastrointest Endosc. 1989;35:381–385.

    Article  CAS  PubMed  Google Scholar 

  7. Kirby DF, Mills PR, Kellum JM, Messmer JM, Sugerman HJ. Incomplete small bowel obstruction by the Garren-Edwards gastric bubble necessitating surgical intervention. Am J Gastroenterol. 1987;82:251–253.

    CAS  PubMed  Google Scholar 

  8. Kramer FM, Stunkard AJ, Spiegel TA, et al. Limited weight losses with a gastric balloon. Arch Intern Med. 1989;149:411–413.

    Article  CAS  PubMed  Google Scholar 

  9. Mathus-Vliegen EM, Eichenberger RI. Fasting and meal-suppressed ghrelin levels before and after intragastric balloons and balloon-induced weight loss. Obes Surg. 2014;24:85–94. doi:10.1007/s11695-013-1053-5.

    Article  CAS  PubMed  Google Scholar 

  10. Martinez-Brocca MA, Belda O, Parejo J, Jimenez L, del Valle A, Pereira JL, Garcia-Pesquera F, Astorga R, Leal-Cerro A, Garcia-Luna PP. Intragastric balloon-induced satiety is not mediated by modification in fasting or postprandial plasma ghrelin levels in morbid obesity. Obes Surg. 2007;17:649–657. Erratum in: Obes Surg. 2007;17:996.

  11. Mathus-Vliegen EM, de Groot GH. Fasting and meal-induced CCK and PP secretion following intragastric balloon treatment for obesity. Obes Surg. 2013;23:622–633. doi:10.1007/s11695-012-0834-6.

    Article  PubMed  Google Scholar 

  12. Ponce J, Quebbemann BB, Patterson EJ. Prospective, randomized, multicenter study evaluating safety and efficacy of intragastric dual-balloon in obesity. Surg Obes Relat Dis. 2013;9:290–295. doi:10.1016/j.soard.2012.07.007.

    Article  PubMed  Google Scholar 

  13. 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;11:874–881.

    Article  PubMed  Google Scholar 

  14. Abu-Dayyeh B. A randomized, multi-center study to evaluate the safety and effectiveness of the orbera intragastric balloon as an adjunct to a behavioral modification program. In: Comparison with a Behavioral Modification Program Alone in the Weight Management of Obese Subjects. Rochester, MN: Mayo Clinic; 2015 (Publication Pending). Online at: http://www.orbera.com/resource/1441904169000/o_orbera_code/pdf/ORBERA_Directions_for_Use_GRF-00346-00R01.pdf.

  15. 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;30:129–133.

    Article  CAS  Google Scholar 

  16. Doldi SB, Micheletto G, Perrini MN, Librenti MC, Rella S. Treatment of morbid obesity with intragastric balloon in association with diet. Obes Surg. 2002;12:583–587.

    Article  CAS  PubMed  Google Scholar 

  17. Imaz I, Martínez-Cervell C, García-Alvarez EE, Sendra-Gutiérrez JM, González-Enríquez J. Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis. J Obes Surg. 2008;18:841–846. doi:10.1007/s11695-007-9331-8.

    Article  Google Scholar 

  18. Orbera Directions for Use. Apollo Endosurgery, Inc. Found on the world wide web at: http://www.orbera.com/resource/1449013205000/o_orbera_code/pdf/ORBERA_Directions_for_Use_GRF-00346-00R01.pdf.

  19. Bužga M, Evžen M, Pavel K, et al. Effects of the intragastric balloon MedSil on weight loss, fat tissue, lipid metabolism, and hormones involved in energy balance. Obes Surg. 2014;24:909–915. doi:10.1007/s11695-014-1191-4.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Machytka E, Klvana P, Kornbluth A, et al. Adjustable intragastric balloons: A 12-month pilot trial in endoscopic weight loss management. Obes Surg. 2011;21:1499–1507. doi:10.1007/s11695-011-0424-z.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Mion F, Ibrahim M, Marjoux S, et al. Swallowable Obalon® gastric balloons as an aid for weight loss: A pilot feasibility study. Obes Surg. 2013;23:730–733. doi:10.1007/s11695-013-0927-x.

    Article  PubMed  Google Scholar 

  22. Giuricin M, Nagliati C, Palmisano S, et al. Short- and long-term efficacy of intragastric air-filled balloon (Heliosphere® BAG) among obese patients. Obes Surg. 2012;22:1686–1689. doi:10.1007/s11695-012-0700-6.

    Article  CAS  PubMed  Google Scholar 

  23. Trande P, Mussetto A, Mirante VG, et al. Efficacy, tolerance and safety of new intragastric air-filled balloon (Heliosphere BAG) for obesity: The experience of 17 cases. Obes Surg. 2010;20:1227–1230. doi:10.1007/s11695-008-9786-2.

    Article  PubMed  Google Scholar 

  24. Forestieri P, De Palma GD, Formato A, et al. Heliosphere Bag in the treatment of severe obesity: Preliminary experience. Obes Surg. 2006;16:635–637.

    Article  CAS  PubMed  Google Scholar 

  25. Lecumberri E, Krekshi W, Matía P, et al. Effectiveness and safety of air-filled balloon Heliosphere BAG® in 82 consecutive obese patients. Obes Surg. 2011;21:1508–1512.

    Article  PubMed  Google Scholar 

  26. Reshape Intergrated Dual Balloon System Intstructions for Use. Found on the World Wide Web at: https://reshapeready.com/wp-content/uploads/2015/07/ReShape_Instructions_For_Use.pdf.

  27. 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;10:474–478. doi:10.1016/j.soard.2013.10.021.

    Article  PubMed  Google Scholar 

  28. Zerrweck C, Maunoury V, Caiazzo R, et al. Preoperative weight loss with intragastric balloon decreases the risk of significant adverse outcomes of laparoscopic gastric bypass in super-super obese patients. Obes Surg. 2012;22:777–782. doi:10.1007/s11695-011-0571-2.

    Article  PubMed  Google Scholar 

  29. 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;14:671–676.

    Article  PubMed  Google Scholar 

  30. Angrisani L, Lorenzo M, Borrelli V, Giuffré M, Fonderico C, Capece G. Is bariatric surgery necessary after intragastric balloon treatment? Obes Surg. 2006;16:1135–1137.

    Article  PubMed  Google Scholar 

  31. Melissas J, Mouzas J, Filis D, et al. The intragastric balloon—smoothing the path to bariatric surgery. Obes Surg. 2006;16:897–902.

    Article  PubMed  Google Scholar 

  32. Frutos MD, Morales MD, Luján J, Hernández Q, Valero G, Parrilla P. Intragastric balloon reduces liver volume in super-obese patients, facilitating subsequent laparoscopic gastric bypass. Obes Surg. 2007;17:150–154.

    Article  PubMed  Google Scholar 

  33. Bariatric Endoscopy Task Force ASGE, Technology Committee ASGE, Abu Dayyeh BK, 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;82:425–438.

    Article  Google Scholar 

  34. Kotzampassi K, Grosomanidis V, et al. 500 intragastric balloons: What happens 5 years thereafter? Obes Surg. 2012;22:896–903.

    Article  PubMed  Google Scholar 

  35. Dogan UB, Gumurdulu Y, Akin MS, Yalaki S. Five percent weight lost in the first month of intragastric balloon treatment may be a predictor for long-term weight maintenance. Obes Surg. 2013;23:892–896.

    Article  PubMed  Google Scholar 

  36. The Six-Month Adjunctive Weight Reduction Therapy (SMART) Trial. 2016; Obalon Therapeutics, Inc. https://clinicaltrials.gov.

  37. 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;12:420–429.

    Article  PubMed  Google Scholar 

  38. Saber AA, Shoar S, Almadani MW, et al. Efficacy of first-time intragastric balloon in weight loss: A systemati review and meta-analysis of randomized controlled trials. Obes Surg. 2017;27:277–287. doi:10.1007/s11695-016-2296-8.

    Article  PubMed  Google Scholar 

  39. Genco A, Dellepiane D, Baglio G, et al. Adjustable intragastric balloon vs non-adjustable intragastric balloon: Case-control study on complications, tolerance, and efficacy. Obes Surg. 2013;23:953–958. doi:10.1007/s11695-013-0891-5.

    Article  PubMed  Google Scholar 

  40. Brooks J, Srivastava ED, Mathus-Vliegen EM. One-year adjustable intragastric balloons: Results in 73 consecutive patients in the U.K. Obes Surg. 2014;24:813–819.

    Article  CAS  PubMed  Google Scholar 

  41. Caglar E, Dobrucali A, Bal K. Gastric balloon to treat obesity: Filled with air or fluid? Dig Endosc. 2013;25:502–507. doi:10.1111/den.12021.

    Article  PubMed  Google Scholar 

  42. De Castro ML, Morales MJ, Del Campo V, et al. Efficacy, safety, and tolerance of two types of intragastric balloons placed in obese subjects: A double-blind comparative study Obes Surg. 2010;20:1642–1646.

    PubMed  Google Scholar 

  43. Giardiello C, Borrelli A, Silvestri E, Antognozzi V, Iodice G, Lorenzo M. Air-filled vs water-filled intragastric balloon: A prospective randomized study. Obes Surg. 2012;22:1916–1919. doi:10.1007/s11695-012-0786-x.

    Article  PubMed  Google Scholar 

  44. Herve J, Wahlen CH, Schaeken A, et al. What becomes of patients one year after the intragastric balloon has been removed? Obes Surg. 2005;15:864–870.

    Article  CAS  PubMed  Google Scholar 

  45. Dastis NS, Francois E, Deviere J, Ilah Mehdi A, Barea M, Dumonceau JM. Intragastric balloon for weight loss: Results in 100 individuals followed for at least 2.5 years. Endoscopy. 2009;41:575–580.

    Article  PubMed  Google Scholar 

  46. Genco A, Balducci S, Bacci V, et al. Intragastric balloon or diet alone? A retrospective evaluation. Obes Surg. 2008;18:989–992.

    Article  PubMed  Google Scholar 

  47. Tai CM, Lin HY, Yen YC, et al. Effectiveness of intragastric balloon treatment for obese patients: One-year follow-up after balloon removal. Obes Surg. 2013;23:2068–2074.

    Article  PubMed  Google Scholar 

  48. Dumonceau JM. Evidence-based review of the Bioenterics Intragastric Balloon for weight loss. Obes Surg. 2008;18:1611–1617.

    Article  PubMed  Google Scholar 

  49. Ricci G, Bersani G, Rossi A, Pigo F, De Fabritiis G, Alvisi V. Bariatric therapy with intragastric balloon improves liver dysfunction and insulin resistance in obese patients. Obes Surg. 2008;18:1438–1442.

    Article  PubMed  Google Scholar 

  50. Folini L, Veronelli A, Benetti A, et al. Liver steatosis (LS) evaluated through chemical-shift magnetic resonance imaging liver enzymes in morbid obesity; effect of weight loss obtained with intragastric balloon gastric banding. Acta Diabetol. 2014;51:361–368.

    Article  CAS  PubMed  Google Scholar 

  51. Lee YM, Low HC, Lim LG, et al. Intragastric balloon significantly improves nonalcoholic fatty liver disease activity score in obese patients with nonalcoholic steatohepatitis: A pilot study. Gastrointest Endosc. 2012;76:756–760.

    Article  PubMed  Google Scholar 

  52. Mafort TT, Madeira E, Guedes EP, et al. Six-month intragastric balloon treatment for obesity improves lung function, body composition, and metabolic syndrome. Obes Surg. 2014;24:232–240.

    Article  PubMed  Google Scholar 

  53. Busetto L, Enzi G, Inelmen EM, et al. Obstructive sleep apnea syndrome in morbid obesity: Effects of intragastric balloon. Chest. 2005;128:618–623.

    Article  PubMed  Google Scholar 

  54. Tette E, Hendrickx L, Pauwels M, Van Hee R. Weight reduction by means of intragastric device: Experience with the bioenterics intragastric balloon. Obes Surg. 2001;11:519–523.

    Article  Google Scholar 

  55. Dumonceau JM, François E, Hittelet A, Mehdi AI, Barea M, Deviere J. Single vs repeated treatment with the intragastric balloon: A 5-year weight loss study. Obes Surg. 2010;20:692–697. doi:10.1007/s11695-010-0127-x.

    Article  PubMed  Google Scholar 

  56. Peker Y, Coskun H, Bozkurt S, Cin N, Atak T, Genc H. Comparison of results of laparoscopic gastric banding and consecutive intragastric balloon application at 18 months: A clinical prospective study. J Laparoendosc Adv Surg Tech A. 2011;21:471–475. doi:10.1089/lap.2010.0439.

    Article  PubMed  Google Scholar 

  57. Alfredo G, Roberta M, Massimiliano C, Michele L, Nicola B, Adriano R. 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;10:307–311.

    Article  PubMed  Google Scholar 

  58. Dargent J, Mion F, et al. Multicenter randomized study of obesity treatment with minimally invasive injection of hyaluronic acid versus and combined with intragastric balloon. Obes Surg. 2015;25:1842–1847.

    Article  PubMed  Google Scholar 

  59. Mathus-Vliegen EM, Tygat GN. Gastro-esophageal reflux in obese subjects: Influence of overweight, weight loss and chronic gastric balloon distention. Scand J Gastroenterol. 2002;37:1246–1252.

    Article  CAS  PubMed  Google Scholar 

  60. Mathus-Vliegen EM, van Weeren M, van Eerten PV. Los function and obesity: The impact of untreated obesity, weight loss, and chronic gastric balloon distention. Digestion. 2003;68:161–168.

    Article  CAS  PubMed  Google Scholar 

  61. Rossi A, Bersani G, et al. Intragastric balloon insertion increases the frequency of erosive esophagitis in obese patients. Obes Surg. 2007;17:1346–1349.

    Article  PubMed  Google Scholar 

  62. Coskun H, Bozkurt S. A case of asymptomatic fungal and bacterial colonization of an intragastric balloon. World J Gastro. 2009;15:5751–5753.

    Article  Google Scholar 

  63. Kotzampassi K, Vasilaki O, et al. Candida albicans colonization on an intragastric balloon. Asian J Endosc Surg. 2013;6:214–216.

    Article  PubMed  Google Scholar 

  64. Kim WY, Kirkpatrick UJ, et al. Large bowel impaction by the BioEnterics Intragastric Balloon (BIB) necessitating surgical intervention. Ann R Coll Surg Engl. 2000;82:202–204.

    CAS  PubMed  PubMed Central  Google Scholar 

  65. Vanden EF, Urbain P. Small intestine gastric balloon impaction treated by laparoscopic surgery. Obes Surg. 2001;11:646–648.

    Article  Google Scholar 

  66. Lopez-Nava G, et al. Dual intragastric balloon: Single ambulatory center Spanish experience with 60 patients in endoscopic weight loss management. Obes Surg. 2015;25:2263–2267.

    Article  CAS  PubMed  Google Scholar 

  67. Mathus-Vliegen EM, Alders PR, Chuttani R, Scherpenisse J. Outcomes of intragastric balloon placements in a private practice setting. Endoscopy. 2015;47:302–307.

    PubMed  Google Scholar 

  68. 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. 2013;21:1561–1570.

    Article  PubMed  Google Scholar 

  69. Majanovic SK, Ruzic A, et al. Comparative study of intragastric balloon and cognitive-behavioral approach for non-morbid obesity. Hepatogastroenterology. 2014;61:937–941.

    PubMed  Google Scholar 

  70. Mathus-Vliegen EM, Tygtat GN. 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;61:19–27.

    Article  PubMed  Google Scholar 

  71. Farina MG, Baratta R, et al. Intragastric balloon in association with lifestyle and/or pharmacotherapy in the long-term management of obesity. Obes Surg. 2012;22:565–571.

    Article  PubMed  Google Scholar 

  72. Lee YM, Low HC, et al. Intragastric balloon significantly improves nonalcoholic fatty liver disease activity score in obese patients with nonalcoholic steatohepatitis: A pilot study. Gastrointest Endosc. 2012;76:761–762.

    Article  Google Scholar 

  73. Middle Georgia Surgical. ORBERA intragastric balloon: A simple, ety powerful, non-surgical weight loss solution. Available at http://www.middlegeorgiasurgical.com/weight-loss-surgery/orbera-intragastric-balloon/. Accessed July 2016.

  74. Reshape Medical. Available at https://reshapeready.com/. Accessed July 2016.

  75. Obalon Therapeutics. Available at http://www.obalon.com/. Accessed July 2016.

  76. Spatz Balloon. Available at http://spatzmedical.com/. Accessed July 2016.

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  1. Department of Gastroenterology and Hepatology, University of Utah, Salt Lake City, UT, USA

    Patrick Laing, Tuan Pham, Linda Jo Taylor & John Fang

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  1. Patrick Laing
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Dr. John Fang is a consultant to Boston Scientific, Covidien, and Obalon Therapeutics. He is also the owner of Veritract. Patrick Laing, Tuan Pham, and Linda Taylor have no conflicts of interest or financial ties to disclose.

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Laing, P., Pham, T., Taylor, L.J. et al. Filling the Void: A Review of Intragastric Balloons for Obesity. Dig Dis Sci 62, 1399–1408 (2017). https://doi.org/10.1007/s10620-017-4566-2

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