Original article
Intragastric balloon outcomes in super-obesity: a 16-year city center hospital series

https://doi.org/10.1016/j.soard.2018.07.010Get rights and content

Highlights

  • Intra-gastric balloons represent an endoscopic therapy aimed at achieving weight loss by mechanical induction of satiety.

  • Our study evaluated the efficacy and safety of intra-gastric balloon therapy at one large city academic bariatric center over a sixteen-year period for super-obese patients.

  • Intra-gastric balloons can offer effective weight loss in selected super-obese patients within a dedicated bariatric centre offering multidisciplinary support.

  • Balloon insertion alone offers only short-term weight loss, however when combined with definite bariatric surgical approaches durable weight loss outcomes can be achieved.

Abstract

Background

Intragastric balloons represent an endoscopic therapy aimed at achieving weight loss by mechanical induction of satiety. Their exact role within the bariatric armamentarium remains uncertain.

Objective

Our study aimed to evaluate the use of intragastric balloon therapy alone and before definitive bariatric surgery over a 16-year period.

Setting

A large city academic bariatric center for super-obese patients.

Methods

Between January 2000 and February 2016, 207 patients underwent ORBERA intragastric balloon placement at esophagogastroduodenoscopy. Four surgeons performed the procedures, and data were entered prospectively into a dedicated bariatric database. Patients’ weight loss data were measured through body mass index (BMI) and excess weight loss and recorded at each clinic review for up to 5 years (60 mo). Treatment arms included intragastric balloon alone with lifestyle therapy or intragastric balloon and definitive bariatric surgery: gastric banding, sleeve gastrectomy, or Roux-en-Y gastric bypass. An additional treatment arm of analysis included the overall results from intragastric balloon followed by stapled procedure.

Results

One hundred twenty-nine female and 78 male patients had a mean age of 44.5 (±11.3) years and a mean BMI of 57.3 (±9.7) kg/m2. Fifty-eight percent of patients suffered from type 2 diabetes. Time from initial or first balloon insertion to definitive surgical therapy ranged between 9 and 13 months. Seventy-six patients had intragastric balloon alone, and 131 had intragastric balloon followed by definitive procedure. At 60 months postoperatively the intragastric balloon alone with lifestyle changes demonstrated an excess weight loss of 9.04% and BMI drop of 3.8; intragastric balloon with gastric banding demonstrated an excess weight loss of 32.9% and BMI drop of 8.9. Intragastric balloon and definitive stapled procedure demonstrated a BMI drop of 17.6 and an excess weight loss of 52.8%. Overall, there were 3 deaths (1.4%), 2 within 10 days due to acute gastric perforation secondary to vomiting and 1 cardiac arrest at 4 weeks postoperatively.

Conclusion

Intragastric balloons can offer effective weight loss in selected super-obese patients within a dedicated bariatric center offering multidisciplinary support. Balloon insertion alone offers only short-term weight loss; however, when combined with definitive bariatric surgical approaches, durable weight loss outcomes can be achieved. A strategy of early and continual vigilance for side effects and a low threshold for removal should be implemented. Surgeon and unit experience with intragastric balloons can contribute to “kick starting” successful weight loss as a bridge to definitive therapy in an established bariatric surgical pathway.

Section snippets

Intragastric balloon technique and follow-up

After the bariatric multidisciplinary decision to perform IGB therapy, informed consent was obtained from patients. General anesthesia was administered, and complete diagnostic gastroduodenoscopy was performed assessing the esophagus, stomach, and duodenum. If no contraindications to balloon insertion were present (e.g., macroscopically visible gastrointestinal pathology or large hiatus hernia), the endoscope was removed and, with anesthetic guidance, a prerolled silicone balloon (ORBERA;

Patient characteristics

Two hundred seven patients were included in the study, of whom 76 (31%) underwent IGB placement only, 51 (21%) had IGB followed by gastric band, 53 (22%) had IGB followed by gastric bypass surgery, and 27 (11%) had IGB followed by gastric sleeve surgery. The choice of intervention was based on a discussion in a dedicated bariatric MDT as well as patient preference. Although the aim of the insertion of gastric balloons was to ultimately prepare patients for definitive bariatric surgery, in

Discussion

Our results demonstrate the long-term weight loss efficacy of IGB when used as an initial weight loss trigger in the context of an established bariatric pathway with definitive bariatric procedures (such as Roux-en-Y gastric bypass and sleeve gastrectomy). While the application of IGBs before definite bariatric surgery is an accepted practice in some centers [32], [33], [34], our results further support this approach, with additional evidence demonstrating the durability of IGBs in SO as a

Conclusion

In this paper, we report our long-term, single-institute experience in using the IGB alone and as a precursor to definite bariatric surgery for SO patients at a large city specialist bariatric center. We show a small effect in weight loss when using IGB and lifestyle changes alone, and these effects appear to be short term. However, a large and sustained weight loss effect is shown when IGBs are combined with definite bariatric surgery, in particular stapled procedures. We suggest that IGBs

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

References (43)

  • G Whitlock et al.

    Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies

    Lancet

    (2009)
  • KM Flegal et al.

    Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis

    JAMA

    (2013)
  • K Peterson et al.

    Evidence brief: the comparative effectiveness of bariatric surgery in super obesity (BMI >50 kg/m2)

    US Department of Veterans Affairs

    (2015)
  • SH Chang et al.

    The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012

    JAMA Surg

    (2014)
  • JL Colquitt et al.

    Surgery for weight loss in adults

    Cochrane Database Syst Rev

    (2014)
  • L Sjöström et al.

    Effects of bariatric surgery on mortality in Swedish obese subjects

    N Engl J Med

    (2007)
  • L Sjöström et al.

    Bariatric surgery and long-term cardiovascular events

    JAMA

    (2012)
  • SH Kim et al.

    Current status of intragastric balloon for obesity treatment

    World J Gastroenterol

    (2016)
  • U.S. Food and Drug Administration CfDaRH, Office for Device Evaluation. Reshape Integrated Dual Balloon System Approval...
  • P Laing et al.

    Filling the void: a review of intragastric balloons for obesity

    Dig Dis Sci

    (2017)
  • BK Abu Dayyeh 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)
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