Endoscopic Volume Adjustment of Intragastric Balloons for Intolerance

Intragastric balloon for obesity

BACKGROUND

Obesity is one of the major public health problems of modern society. Intragastric balloon (IGB) treatment for obesity has been developed as a temporary aid. Its primary objective is the treatment of obese people, who have had unsatisfactory results in their clinical treatment for obesity, despite of being cared for by a multidisciplinary team, and super obese patients with a higher surgical risk. However, the effects of different IGB procedures compared with conventional treatments and with each other are uncertain.

OBJECTIVES

To assess the effects of intragastric balloon in people with obesity.

SEARCH STRATEGY

Studies were obtained from computerised searches of MEDLINE, EMBASE, LILACS, The Cochrane Library and other electronic databases. Furthermore, reference lists of relevant articles and hand searches of selected journals were performed. Experts in the field were contacted.

SELECTION CRITERIA

Randomised and quasi-randomised controlled trials fulfilling the inclusion criteria were used. Short term weight loss is common, so studies were included if they reported measurements after a minimum of four weeks follow-up.

DATA COLLECTION AND ANALYSIS

Data were extracted by one reviewer and checked independently by two reviewers. Two reviewers independently assessed the quality of trials.

MAIN RESULTS

Nine randomised controlled trials involving 395 patients were included. Six out of nine studies had a follow-up of less than one year, the longest study duration was 24 months. Only a third of the analysed studies revealed a low risk of bias. No information was available on quality of life, all-cause mortality and morbidity. Compared with conventional management, IGB did not show convincing evidence of a greater weight loss. On the other hand, complications of intragastric balloon placement occurred, however few of a serious nature. The relative risks for minor complications like gastric ulcers and erosions were significantly raised.

AUTHORS' CONCLUSIONS

Evidence from this review is limited for decision making, since there was large heterogeneity in IGB trials, regarding both methodological and clinical aspects. However, a co-adjuvant factor described by some authors in the loss and maintenance of weight has been the motivation and the encouragement to changing eating habits following a well-organized diet and a program of behavioural modification. The IGB alone and the technique of positioning appear to be safe. Despite the evidence for little additional benefit of the intragastric balloon in the loss of weight, its cost should be considered against a program of eating and behavioural modification.

Endoscopic treatments for obesity: past, present and future

Obesity is recognized as a serious, chronic illness affecting all ages. The cause for obesity is multi-factorial, which makes successful management complex and challenging. Meaningful weight loss is frequently difficult to achieve, particularly when the goal is not merely to lose weight but to maintain this loss. The efficacy of future endoscopic approaches needs to be validated through well-designed controlled studies, and verification of safety is essential. Endoluminal therapies must have a sound physiologic basis for their development. The availability of specialized radionuclide imaging of gastric capacity and accommodation provide a useful tool in constructing interventions. Endotherapy is likely best suited for nonmorbid obese individuals with BMI ranging from 30 to 39 or as a budge to bariatric surgery. This specific BMI range has been targeted by the National Institutes of Health for emerging technologies. Presurgical weight loss to reduce surgical risk is another potential target group. Regardless of which endoscopic methods prevail, patients will continue to require a comprehensive, multi-modality management approach to this complex disease.