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Vargas EJ, Pesta CM, Bali A, Ibegbu E, Bazerbachi F, Moore RL, Kumbhari V, Sharaiha RZ, Curry TW, DosSantos G, Schmitz R, Agnihotri A, Novikov AA, Pitt T, Dunlap MK, Herr A, Aronne L, Ledonne E, Kadouh HC, Cheskin LJ, Mundi MS, Acosta A, Gostout CJ, Abu Dayyeh BK. Single Fluid-Filled Intragastric Balloon Safe and Effective for Inducing Weight Loss in a Real-World Population. Clin Gastroenterol Hepatol 2018; 16:1073-1080.e1. [PMID: 29425781 PMCID: PMC6008169 DOI: 10.1016/j.cgh.2018.01.046] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/16/2018] [Accepted: 01/21/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The Orbera intragastric balloon (OIB) is a single fluid-filled intragastric balloon approved for the induction of weight loss and treatment of obesity. However, little is known about the effectiveness and safety of the OIB outside clinical trials, and since approval, the Food and Drug Administration has issued warnings to health care providers about risk of balloon hyperinflation requiring early removal, pancreatitis, and death. We analyzed data on patients who have received the OIB since its approval to determine its safety, effectiveness, and tolerance in real-world clinical settings. METHODS We performed a postregulatory approval study of the safety and efficacy of the OIB, and factors associated with intolerance and response. We collected data from the Mayo Clinic's database of patient demographics, outcomes of OIB placement (weight loss, weight-related comorbidities), technical aspects of insertion and removal, and adverse events associated with the device and/or procedure, from 8 centers (3 academic, 5 private, 4 surgeons, and 4 gastroenterologists). Our final analysis comprised 321 patients (mean age, 48.1 ± 11.9 y; 80% female; baseline body mass index, 37.6 ± 6.9). Exploratory multivariable linear and logistic regression analyses were performed to identify predictors of success and early balloon removal. Primary effectiveness outcomes were percentage of total body weight lost at 3, 6, and 9 months. Primary and secondary safety outcomes were rates of early balloon removal, periprocedural complications, dehydration episodes requiring intravenous infusion, balloon migration, balloon deflation or hyperinflation, pancreatitis, or other complications. RESULTS Four patients had contraindications for placement at the time of endoscopy. The balloon was safely removed in all instances with an early removal rate (before 6 months) in 16.7% of patients, at a median of 8 weeks after placement (range, 1-6 mo). Use of selective serotonin or serotonin-norepinephrine re-uptake inhibitors at the time of balloon placement was associated with increased odds of removal before 6 months (odds ratio, 3.92; 95% CI, 1.24-12.41). Total body weight lost at 3 months was 8.5% ± 4.9% (n = 204), at 6 months was 11.8% ± 7.5% (n = 199), and at 9 months was 13.3% ± 10% (n = 47). At 6 months, total body weight losses of 5%, 10%, and 15% were achieved by 88%, 62%, and 31% of patients, respectively. Number of follow-up visits and weight loss at 3 months were associated with increased weight loss at 6 months (β = 0.5 and 1.2, respectively) (P < .05). Mean levels of cholesterol, triglycerides, low-density lipoprotein, and hemoglobin A1c, as well as systolic and diastolic blood pressure, were significantly improved at 6 months after OIB placement (P < .05). CONCLUSIONS In an analysis of a database of patients who received endoscopic placement of the OIB, we found it to be safe, effective at inducing weight loss, and to reduce obesity-related comorbidities in a real-world clinical population. Rates of early removal (before 8 weeks) did not differ significantly between clinical trials and the real-world population, but were affected by use of medications.
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Affiliation(s)
- Eric J Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - Ahmad Bali
- Bali Surgical Practice, South Charleston, West Virginia
| | - Eric Ibegbu
- Atlantic Medical Group, Kinston, North Carolina
| | - Fateh Bazerbachi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - Vivek Kumbhari
- Division of Gastroenterology, John Hopkins University School of Medicine, Baltimore, Maryland
| | - Reem Z Sharaiha
- Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York
| | | | | | | | - Abhishek Agnihotri
- Division of Gastroenterology, John Hopkins University School of Medicine, Baltimore, Maryland
| | - Aleksey A Novikov
- Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York
| | - Tracy Pitt
- Journey Lite Surgery Center, Cincinnati, Ohio
| | - Margo K Dunlap
- Division of Gastroenterology, John Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrea Herr
- Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York
| | - Louis Aronne
- Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York
| | | | - Hoda C Kadouh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Lawrence J Cheskin
- Division of Gastroenterology, John Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Manpreet S Mundi
- Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Andres Acosta
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
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Musielak MC, Patel HK, Curry TW, Fegelman EJ. Laparoscopic Gastric Band Erosion: A Retrospective Analysis and Review of Management. Bariatr Surg Pract Patient Care 2014. [DOI: 10.1089/bari.2014.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Hiral K. Patel
- Department of Surgery, The Jewish Hospital, Cincinnati, Ohio
| | - Trace W. Curry
- Department of Surgery, The Jewish Hospital, Cincinnati, Ohio
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