Adjustable intragastric balloon for obesity

Abstract

We congratulate Barham K Abu Dayehh and colleagues and their collaborators for the completion of such laborious work. They show an adequate weight loss with adjustable intragastric balloon, and an acceptable safety profile.1Abu Dayyeh BK Maselli DB Rapaka B et al.Adjustable intragastric balloon for treatment of obesity: a multicentre, open-label, randomised clinical trial.Lancet. 2021; 398: 1965-1973Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar However, if the upward adjustment eligibility criteria included inadequate weight loss at week 18, why did patients undergoing adjustment already lose more weight at week 18 than those not undergoing adjustment? One would expect the trend lines to cross at some point, which did not happen. Second, what was the diet regimen after adjustment? For example, were patients instructed to follow a liquid or pasty diet? Instructions concerning calories per day were provided; however, we would also have appreciated information on diet consistency and further clarity around the adaption period. Finally, patients tend to lose weight after any interventional procedure given three simultaneous forces: psychological stimulus (the placebo effect); novel dietary restrictions; and the actual physiological pathway that increases satiety and satiation.2Panayotov VS Studying a possible placebo effect of an imaginary low-calorie diet.Front Psychiatry. 2019; 10: 550Crossref PubMed Scopus (7) Google Scholar, 3Fontaine KR Williams MS Hoenemeyer TW Kaptchuk TJ Dutton GR Placebo effects in obesity research.Obesity (Silver Spring). 2016; 24: 769-771Crossref PubMed Scopus (14) Google Scholar The investigators reiterate the physiological pathway in their Article but do not consider other co-acting forces. The two studies cited also failed to discuss that additional weight loss could be due to those other forces rather than merely an increased balloon volume.4Machytka E Brooks J Buzga M Mason J One year adjustable intragastric balloon: safety and efficacy of the Spatz3 adjustable balloons [version 1; peer review: 2 approved with reservations].F1000Research. 2014; 3: 1-7Crossref PubMed Google Scholar, 5Brooks J Srivastava ED Mathus-Vliegen EMH One-year adjustable intragastric balloons: results in 73 consecutive patients in the UK.Obes Surg. 2014; 24: 813-819Crossref PubMed Scopus (70) Google Scholar VOB has received personal fees for lectures from Erbe Elektromedizin. MGN is a consultant for GI Dynamics, Apollo Endosurgery, USGI Medical, ColubrisMX, Scitech, and MITech; Scientific Advisor for Apollo Endosurgery and Keyron; and speaker for Olympus, Erbe, and Meditronics, all of which are unrelated to this Correspondence. Adjustable intragastric balloon for obesityWe agree with Barham K Abu Dayyeh and colleagues1 that “invasiveness, expense, long-term risks, and patients’ acceptance” reduce the popularity of bariatric surgery, which they demonstrate in the context of a well designed multicentre, randomised trial that supports the safety and efficacy of the adjustable intragastric balloon. Full-Text PDF Adjustable intragastric balloon for obesity – Author's replyWe appreciate the opportunity to address our colleagues’ queries in response to our study investigating the adjustable intragastric balloon for obesity.1 Full-Text PDF Adjustable intragastric balloon for treatment of obesity: a multicentre, open-label, randomised clinical trialWhen aIGB was combined with lifestyle modification, significant weight loss was achieved and maintained for 6 months following removal. Balloon volume adjustability permitted individualised therapy, maximising weight loss and tolerance. Full-Text PDF