Intragastric balloon therapy is an endoscopic and temporary method of inducing weight loss. It entails placing a soft saline- or gas-filled balloon in the stomach to promote a feeling of satiety and restriction. Because its weight loss mechanism is mostly restrictive, its efficacy largely relies upon a patient’s adherence to lifestyle changes (ie, diet and exercise).
Intragastric balloon therapy is an option for the treatment of obesity in patients with a body mass index (BMI) of greater than 30 kg/m2. Patients must have failed previous attempts at other procedures for weight loss, as in with diet and exercise alone. Intragastric balloon therapy can be used for overweight or obese patients who do not yet meet BMI criteria for surgery. In patients who are candidates for bariatric surgery, intragastric balloon therapy can be used as a bridge to surgery (when BMI ≥50 kg/m2) or in place of surgery for those who refuse or who lack access to surgery.
Absolute contraindications to intragastric balloon therapy include previous gastric surgery, coagulation disorders, any bleeding lesion in the gastrointestinal tract, pregnancy or desire to become pregnant, alcoholism or drug addiction, severe liver disease, and any contraindication to endoscopy. Relative contraindications include previous abdominal surgery, large hiatal hernia, inflammatory bowel disease, chronic nonsteroidal anti-inflammatory drug use, and psychiatric disorders.
Intragastric balloons differ in their volume, duration in the stomach, adjustability, and means of insertion and removal:
- Orbera and ReShape are endoscopically inserted and removed balloons that remain in the stomach for six months. Both balloons have been approved by the US Food and Drug Administration (FDA).
- Obalon balloons are swallowed but endoscopically removed at six months; the aggregate volume varies depending upon the number of balloons inserted (one to three). Obalon balloons have also received FDA approval.
Intragastric balloon therapy can achieve 8 to 15 percent total body weight loss (or 25 to 38 percent excess weight loss) depending on the type of balloon used. Although there are no direct comparison trials, this degree of short-term weight loss compares favorably with behavior modification or pharmacotherapy but less favorably with bariatric surgery.
During the first week of intragastric balloon therapy, a majority of patients will develop some form of gastrointestinal symptoms due to gastric accommodation to the balloon. The combination of a proton pump inhibitor, an antiemetic, and an anticholinergic helps most patients through the first week of therapy, after which time the symptoms greatly diminish. Serious adverse events can, but rarely, occur during intragastric balloon therapy and can be minimized by thorough patient education, closely monitoring for complications, timely balloon removal.
Regaining of lost weight is a common problem in treating obesity. After intragastric balloon therapy, behavior modification (diet, exercise, lifestyle changes) should be continued to minimize subsequent weight gain. Additional adjunctive measures to sustain or augment weight loss after intragastric balloon therapy include weight loss medications, visits to a weight loss clinic or or with a weight loss coach, repeated balloon therapy after at least a one-month “balloon holiday,” or bariatric surgery.
Source: Uptodate ®