Intragastric Balloon Research Articles

Losing weight to achieve joint or hernia surgery: is the intragastric balloon the answer?

Obesity is an epidemic, with its accompanying medical conditions putting patients at increased risk of postoperative complications. For patients undergoing elective surgery, preoperative weight loss provides an opportunity to decrease complications. We sought to evaluate the safety and efficacy of an intragastric balloon in achieving a body mass index (BMI) < 35kg/m2 prior to elective joint replacement or hernia repair. Retrospective review of all patients who had intragastric balloon placement at a level 1A VA medical center from 1/2019 to 1/2023. Patients who had a scheduled qualifying procedure (knee/hip replacement or hernia repair) and had a BMI > 35kg/m2 were offered intragastric balloon placement to achieve 30-50lbs (13-28kg) weight loss prior to surgery. Participation in a standardized weight loss program for 12months was required. Balloons were removed 6months after placement, preferentially concomitant with the qualifying procedure. Baseline demographics, duration of balloon therapy, weight loss and progression to qualifying procedure were recorded. Twenty patients completed intragastric balloon therapy and had balloon removal. Mean age 54 (34-71years), majority (95%) male. Mean balloon duration was 200 ± 37days. Mean weight loss was 30.8 ± 17.7lbs (14.0 ± 8.0kg) with an average BMI reduction of 4.4 ± 2.9. Seventeen (85%) patients were successful, 15 (75%) underwent elective surgery and 2 (10%) were no longer symptomatic after weight loss. Three patients (15%) did not lose sufficient weight to qualify or were too ill to undergo surgery. Nausea was the most frequent side effect. One (5%) patient was readmitted within 30days for pneumonia. Intragastric balloon placement resulted in an average 30lbs (14kg) weight loss over 6months allowing more than 75% of patients to undergo joint replacement or hernia repair at an optimal weight. Intragastric balloons should be considered in patients requiring 30-50lbs (13-28kg) weight loss prior to elective surgery. More study is needed to determine the long-term benefit of preoperative weight loss prior to elective surgery.

Weight Loss Success With Repeat Intragastric Balloon Placement After Hyperinflation and Removal of the Index Balloon

ABSTRACT Intragastric balloons are an increasingly common endoscopic alternative to bariatric surgery for the treatment of obesity. Hyperinflation is a rare complication that presents as acute-onset epigastric pain, nausea, vomiting, early satiety, abdominal distention or bloating, and rapid weight loss. Hyperinflation requires prompt diagnosis and removal of the balloon to prevent complications including gastric outlet obstruction or gastric perforation. We present a case of intragastric balloon hyperinflation with removal of the index device, followed by replacement with a second balloon, resulting in continued weight loss without further adverse events.

A276 The swallowable intragastric balloon: a retrospective analysis of safety and effectiveness for the treatment of overweight and obesity

A276 The swallowable intragastric balloon: a retrospective analysis of safety and effectiveness for the treatment of overweight and obesity

A049 Prevention and management of nausea and vomiting after swallowable intragastric balloon placement

A049 Prevention and management of nausea and vomiting after swallowable intragastric balloon placement

Bariatric endoscopic antral myotomy: first-in-human proof of concept of a novel therapeutic method to delay gastric emptying and induce weight loss

Bariatric endoscopic antral myotomy: first-in-human proof of concept of a novel therapeutic method to delay gastric emptying and induce weight loss

Research progresses on interventions of obesity in children and adolescents

Childhood and adolescent obesity has become a global epidemic. The interventions mainly include lifestyle intervention, medication treatment and bariatric surgery. Among them, lifestyle intervention, especially intensive lifestyle intervention with participation of family members, is the first-line treatment for obesity in children and adolescents. Both medication and bariatric surgery are adjuvant treatments for severely obese children and adolescents. Currently, metformin is the most widely used drug for the treatment of obesity in children and adolescents in both China and other countries; orlistat and liraglutide are also the drugs that are safe and often used in other countries; other drugs are not recommended. As a tertiary prevention and treatment strategy for obesity, bariatric surgery should be carried out on the basis of good compliance from both the children and their family members, with the cooperation of multiple disciplines. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most common types of procedure performed. Meanwhile, as a new treatment method, intra-gastric balloon procedure needs to be paid more attention to its efficacy and safety.

Progress in the study of intragastric occupancy device for weight reduction.

Obesity is a global public health problem that imposes a heavy economic burden on society. The current main strategies for treating obesity include lifestyle interventions, pharmacological treatments, endoscopic treatments and metabolic surgery. With the development of medical technology, weight reduction by intragastric occupancy devices represented by intragastric balloons and intragastric capsules are gradually emerging. Intragastric balloons are used to reduce weight by occupying the volume of the stomach with balloons filled with different volumes of gas or liquid, among which ReShape, Orbera, Obalon, Elipse and Spatz balloons are gradually used in patients with mild to moderate obesity due to their non-invasive, high safety and reusable advantages. Intragastric capsules are recommended in overweight and obese patients for weight loss through hydrogels with transient superabsorbent swelling properties and completely noninvasive. Both approaches achieve weight loss by limiting gastric volume, increasing satiety and reducing food intake. Despite the presence of adverse gastrointestinal events associated with nausea, vomiting, and abdominal distention, they offer new ideas for the non-invasive clinical treatment of obesity.

Small Bowel Obstruction due to the Impaction of an Intragastric Balloon

We report the case of a 42 year old patient who was admitted to the emergency room for acute small bowel obstruction due to the impaction of an intragastric balloon, previously placed endoscopically for morbid obesity. The patient had surgical extraction through a laparoscopic enterotomy. No postoperative follow-up was noted. We performed an overall review of the results and complications of the endoscopic intragastric balloon as a therapeutic option in patients with severe obesity.

Very Low-Calorie Ketogenic Diet (VLCKD) as Pre-Operative First-Line Dietary Therapy in Patients with Obesity Who Are Candidates for Bariatric Surgery.

Bariatric surgery is currently the most effective method for achieving long-term weight loss and reducing the risk of comorbidities and mortality in individuals with severe obesity. The pre-operative diet is an important factor in determining patients' suitability for surgery, as well as their post-operative outcomes and success in achieving weight loss. Therefore, the nutritional management of bariatric patients requires specialized expertise. Very low-calorie diets and intragastric balloon placement have already been studied and shown to be effective in promoting pre-operative weight loss. In addition, the very low-calorie ketogenic diet has a well-established role in the treatment of obesity and type 2 diabetes mellitus, but its potential role as a pre-operative dietary treatment prior to bariatric surgery has received less attention. Thus, this article will provide a brief overview of the current evidence on the very low-calorie ketogenic diet as a pre-operative dietary treatment in patients with obesity who are candidates for bariatric surgery.

Brazilian guide to nutrition in bariatric and metabolic surgery.

Brazilian nutrition recommendations for bariatric and metabolic surgery aim to provide knowledge, based on scientific evidence, on nutritional practices related to different surgical techniques in the surgical treatment of obesity and metabolic diseases. A systematic literature search was carried out with the appropriate MeSH terms using Medline/Pubmed/LiLACS and the Cochrane database, with the established criteria being based on the inclusion of articles according to the degree of recommendation and strength of evidence of the Classification of Recommendations, Evaluation, Development, and Evaluation System (GRADE). The recommendations that make up this guide were gathered to assist in the individualized clinical practice of nutritionists in the nutritional management of patients with obesity, including nutritional management in the intragastric balloon; pre and postoperative nutritional treatment and supplementation in bariatric and metabolic surgeries (adolescents, adults, elderly, pregnant women, and vegetarians); hypoglycemia and reactive hyperinsulinemia; and recurrence of obesity, gut microbiota, and inflammatory bowel diseases. We believe that this guide of recommendations will play a decisive role in the clinical practice of nutritionists who work in bariatric and metabolic surgery, with its implementation in health services, thus promoting quality and safety in the treatment of patients with obesity. The concept of precision nutrition is expected to change the way we understand and treat these patients.

The Swallowable Intragastric Balloon Combined with Lifestyle Coaching: Short-Term Results of a Safe and Effective Weight Loss Treatment for People Living with Overweight and Obesity

BackgroundSome patients with overweight or obesity are not eligible for surgery according to international guidelines or do not wish a surgical intervention. For these patients, different treatment options are being explored. In this study, we examined the effectiveness of the swallowable intragastric balloon (IB) combined with lifestyle coaching, in patients living with overweight and obesity.MethodA retrospective data study was conducted on patients with a swallowable IB placement between December 2018 and July 2021, combined with a 12-month coaching program. Before balloon placement, patients underwent multidisciplinary screening. The IB was swallowed and filled with fluid once in the stomach and naturally excreted around 16 weeks.ResultsA total of 336 patients, 71.7% female, were included with a mean age of 45.7 (±11.7) years. Mean baseline weight and BMI were 107.54 (±19.16) kg and 36.1 (±5.02) kg/m2. After 1 year, the mean total weight loss was 11.0% (±8.4). The mean placement duration was 13.1 (±2.82) min, and in 43.7%, a stylet was used to facilitate placement. The most common symptoms were nausea (80.4%) and gastric pain (80.3%). In the majority of patients, complaints were resolved within a week. The early deflation of the balloon occurred in 8 patients (2.4%) of which one showed symptoms suggesting a gastric outlet obstruction.ConclusionGiven the low rate of long-term complaints while providing a positive effect on weight loss, we conclude that the swallowable intragastric balloon, combined with lifestyle coaching, is a safe and effective treatment option for patients living with overweight and obesity.Graphical

Factors of Affecting the Success of Intragastric Balloon.

Our aim was to determine the efficacy and safety of intragastric balloon (IGB) application and the factors affecting its success by evaluating the results of patients who underwent IGB. A total of 277 consecutive patients that underwent IGB between January 2019-September 2020 in our clinic were evaluated. Patients' demographic data, height and weight before the IGB procedure, weight at 6 and 12 months after the procedure, follow-up period, complication status, and whether they received dietician's assistance during the follow-up were recorded. In 5 (1.8%) patients, IGB was removed for various reasons before the standard period of 6 months. The mean age of the patients was 35.6±9.5 years, the mean baseline weight and body mass index (BMI) was 92.6±14kg and 33.5±5.4kg/m 2 respectively. The mean follow-up time was 13±4.9 months, whereas in 146(53.6%) patients the follow-up was≥12 months. In the 6-month follow-up, the mean %excess weight loss and %body weight loss were 65.65±25.19% and 14.69±6.96%, respectively, whereas at the 12-month follow-up they were 32.38±24.79% and 6.56±5.31%, respectively. High BMI (odds ratio=1.2, 95% CI=1.0-1.2) and not receiving dietitian's assistance (odds ratio=8.5, 95% CI=3.1-23.7) were independent risk factors for unsuccessful IGB application at both 6-month and 12-month follow-ups. IGB application is a relatively effective and safe weight loss treatment for overweight and obese individuals. High BMI and not getting help from a dietician are risk factors for failure of IGB. To increase compliance with dieticians and therefore success of IGB application, patients should undergo psychiatric evaluation before IGB procedure, and receive psychiatric support, if necessary.

NAFLD: A pretransplant and post-transplant conundrum.

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Epidemiology of the surgical management of obesity.

Surgical interventions for obesity have quintupled in the world in 15 years (140,000 in 2003 vs. 720,000 in 2018), however growth has slowed since 2011. This progressive increase varies by country and from 2008 through 2018, 6.5 million people have undergone bariatric surgery. Growth was strongest in the Asia/Pacific region. Belgium is the country performing the most operations per number of inhabitants: (127 operations per 100,000). France is in 7th place with 72 operations per 100,000 and 70% of patients are operated in surgical services that perform more than 100 procedures per year. The sleeve gastrectomy (SG) is the most commonly performed intervention while the adjustable gastric band (AGB) has practically disappeared. Along with the intragastric balloon, novel endoluminal procedures are being evaluated. A real management policy is needed to respond to this evolution of both epidemiology and techniques.

PRELIMINARY ANALYSIS OF BRAIN PERFUSION OBTAINED WITH ARTERIAL SPIN LABELING METHOD (ASL) USED TO EVALUATE THE EFFECTS OF TYPE 2 DIABETES IN MORBIDLY OBESE PATIENTS

Introduction: Earlier studies demonstrated that obesity was associated with lower cerebral perfusion in obese participants, as compared to participants at normal weight, especially in frontal grey matter regions. On the other hand, type 2 diabetes is a common co-morbid condition among obese patients, and it is associated per se with brain structural and metabolic abnormalities that are related to lower cerebral blood flow (CBF). Unfortunately, only two studies evaluated the effects on co-morbid T2D on CBF, one of them in adolescent population. Therefore, the aim of this study was to establish a pipeline process to quantify CBF images that were obtained in an independent project evaluating brain abnormalities associated with morbid obesity and their resolution with intragastric balloon – an invasive method to reduce weight. Furthermore, we compared CBF between obese patients with and without type 2 diabetes, as well as controls at normal weight. Methods: A processing pipeline utilizing SPM12 toolbox and digital maps (AAL, Brodmann) was established to automatically pre-process scans and toolbox REX was used to prepare data for statistical analysis. We used it to analyze data for six morbidly obese patients with type 2 diabetes T2D (O-T2D) (average age = 48.5 ± 7.9, average body weight = 125.0 ± 29.8 kg, average BMI = 42.0 ± 9.4), eight morbidly obese patients without T2D (O-NT2D) (average age = 39.1 ± 16.1, average body weight = 138.2 ± 14.9 kg, average BMI = 50.2 ± 6.5) and eight healthy controls with normal weight (CON) (average age = 43.5 ± 11.5, average body weight = 67.4 ± 14.6 kg, average BMI = 23.4 ± 3.5). All studies were performed at the CNS Lab MRI Centre, NIBBE. Results: These preliminary analyses demonstrated lower cerebral blood flow in frontal cortex in obese patients with T2D, as compared to obese patients without T2D and controls. Conclusion: A pipeline to numerically process ASL-CBF data was created and used to analyse the small dataset. The analyses indicated that not morbid obesity per se, but morbid obesity combined with co-morbid type 2 diabetes is associated with widespread reductions in cerebral perfusion. The results are in line with other studies that were limited to subjects with lower stages of overweight and obesity. We believe that this methodology may be applied to study changes in brain perfusion evoked by simulated hypergravity with Lower Body Negative Pressure (LBNP) device placed within a magnetic resonance scanner or perfusion changes induced by hypoxia.

Perforated gastric ulcer after unhealthy decisions in a patient with an intragastric balloon, a hangover you will regret

BackgroundPerforated gastric ulcers are life-threatening surgical emergencies that need early diagnosis and treatment to overcome severe complications. With the rise of obesity in recent years, intragastric balloons have arisen as a "safe" strategy; however, in medicine, no treatment is risk-free. Nausea, pain, vomiting, and more severe complications like perforation, ulceration, and death can occur.Case presentationWe present the case of a 28-year-old man with obesity; treatment with an intragastric balloon was initiated with good results at the beginning of his treatment. However, he neglected his treatment over time and made unhealthy choices, leading to a severe complication. However, thanks to prompt surgical treatment, he made a full recovery.Complications:Gastric perforation following an intragastric balloon is a severe and potentially life-threatening complication that an experienced multidisciplinary team must treat promptly and, more importantly, prevent.

A Comprehensive Review on Bariatric Endoscopy: Where We Are Now and Where We Are Going

Background: Obesity is a chronic disease that impairs quality of life and leads to several comorbidities. When conservative therapies fail, bariatric surgical options such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most effective therapies to induce persistent weight loss. Over the last two decades, bariatric endoscopy has become a valid alternative to surgery in specific settings. Primary bariatric endoscopic therapies: Restrictive gastric procedures, such as intragastric balloons (IGBs) and endoscopic gastroplasty, have been shown to be effective in inducing weight loss compared to diet modifications alone. Endoscopic gastroplasty is usually superior to IGBs in maintaining weight loss in the long-term period, whereas IGBs have an established role as a bridge-to-surgery approach in severely obese patients. IGBs in a minority of patients could be poorly tolerated and require early removal. More recently, novel endoscopic systems have been developed with the combined purpose of inducing weight loss and improving metabolic conditions. Duodenal mucosal resurfacing demonstrated efficacy in this field in its early trials: significant reduction from baseline of HbA1c values and a modest reduction of body weight were observed. Other endoscopic malabsorptive have been developed but need more evidence. For example, a pivotal trial on duodenojejunal bypasses was stopped due to the high rate of severe adverse events (hepatic abscesses). Optimization of these more recent malabsorptive endoscopic procedures could expand the plethora of bariatric patients that could be treated with the intention of improving their metabolic conditions. Revisional bariatric therapies: Weight regain may occur in up to one third of patients after bariatric surgery. Different endoscopic procedures are currently performed after both RYGB and SG in order to modulate post-surgical anatomy. The application of argon plasma coagulation associated with endoscopic full-thickness suturing systems (APC-TORe) and Re-EndoSleeve have shown to be the most effective endoscopic treatments after RYGB and SG, respectively. Both procedures are usually well tolerated and have a very low risk of stricture. However, APC-TORe may sometimes require more than one session to obtain adequate final results. The aim of this review is to explore all the currently available primary and revisional endoscopic bariatric therapies focusing on their efficacy and safety and their potential application in clinical practice.

THE WEIGHT-REDUCING EFFECT OF ENDOSCOPICALLY–INSERTED INTRAGASTRIC BALLOONS FOR OBESE PATIENTS FAILED WEIGHT CONTROL WITH LIFESTYLE MODIFICATION AND DRUGS

Background &#x0D; The Food and Drug Administration (FDA) recently approved three intragastric balloons (IGB) devices, ReShape, ORBERA™, and Obalon, for treating obesity. Given the high cost, complication risk, and invasiveness of bariatric surgery, IGB treatment may present a safer and lower-cost option for weight reduction. IGBs are generally placed in the stomach endoscopically for up to 6 months to reduce gastric capacity, enhance feelings of fullness, and induce weight loss. The mechanism of action likely involves stimulation of gastric mechanoreceptors triggering short-acting vagal signals to brain regions implicated in satiety. Balloon efficacy may be influenced by balloon volume, patient gastric capacity, and treatment duration.&#x0D; Objectives &#x0D; To evaluate the efficacy, tolerability, and safety of intra-gastric balloons on weight reduction versus obese patients’ failed weight controlled by dietary changes and drugs.&#x0D; Methods&#x0D; A retrospective study was performed in Sulaimani City from 2017 to Feb./2018. We included 40 obese patients by the World Health Organization (WHO) definition of BMI≥30. The subjects aged 18-68 years with intra-gastric balloons were inserted by endoscopy for 4-9 months. Anthropometric measurements were obtained before, during and after the removal of intra-gastric balloons.&#x0D; Results&#x0D; In total, 40 cases of obese patients, 21 (52.5%) females and 19 (47.5%) males. The mean age was 37.1±11.70years with a range of 18-68 years. BMI and weight significantly reduced early 3-month mean weight 12.78±2.81 Kg, and late 6-month mean weight 9.05±1.89 Kg and around 21 Kgs at removal. Only one patient was the IGB removed early by four months and was not included. Late one year after IGB removal, the long-term effect on BMI and weight were recorded and maintained in most persons. &#x0D; Conclusion&#x0D; Intragastric balloon (IGB) was effective in our study. The observed weight reduction was maintained through 1 year after removal &amp; IGB appeared safe and tolerable &amp; satisfactory for most obese subjects.

Bariatric endoscopy: from managing complications to primary metabolic procedures.

Obesity is a worldwide epidemic and is the second leading cause of preventable death. The approach to treating obesity involves a multidisciplinary approach including lifestyle interventions, pharmacological therapies, and bariatric surgery. Endoscopic interventions are emerging as important tools in the treatment of obesity with primary and revisional bariatric endoscopic therapies. These include intragastric balloons, aspiration therapy, suturing and plication, duodenal-jejunal bypass liners, endoscopic duodenal mucosal resurfacing, and incisionless magnetic anastomosis systems. Endoscopic interventions have also demonstrated efficacy in treating complications of bariatric surgery. Approaches include stenting, endoscopic internal drainage, and endoscopic vacuum-assisted closure. This review aimed to discuss the current endoscopic procedures used as primary and revisional bariatric therapy including those used for managing bariatric surgical complications.

MicroRNA-181a contributes to gastric hypersensitivity in rats with diabetes by regulating TLR4 expression.

Aim: The aim of this study is to investigate the mechanism and interaction of microRNA-181a (miR-181a), toll-like receptor 4 (TLR4) and nuclear factor-kappa B (NF-κB) in gastric hypersensitivity in diabetic rats. Methods: Diabetes was induced by a single intraperitoneal injection of streptozotocin (STZ; 65mg/kg) in female SD rats. Gastric balloon distension technique was used to measure diabetic gastric hypersensitivity. Gastric-specific (T7-T10) dorsal root ganglion (DRG) neurons were acutely dissociated to measure excitability with patch-clamp techniques. Western blotting was employed to measure the expressions of TLR4, TRAF6 and NF-κB subunit p65 in T7-T10 DRGs. The expressions of microRNAs in T7-T10 DRGs were measured with quantitative real-time PCR and fluorescence in situ hybridization. Dual-luciferase reporter gene assay was used to detect the targeting regulation of microRNAs on TLR4. Results: (1) Diabetic rats were more sensitive to graded gastric balloon distention at 2 and 4weeks. (2) The expression of TLR4 was significantly up-regulated in T7-T10 DRGs of diabetic rats. Intrathecal injection of CLI-095 (TLR4-selective inhibitor) attenuated diabetic gastric hypersensitivity, and markedly reversed the hyper-excitability of gastric-specific DRG neurons. (3) The expressions of miR-181a and miR-7a were significantly decreased in diabetic rats. MiR-181a could directly regulate the expression of TLR4, while miR-7a couldn't. (4) Intrathecal injection of miR-181a agomir down-regulated the expression of TLR4, reduced the hyper-excitability of gastric-specific neurons, and alleviated gastric hypersensitivity. (5) p65 and TLR4 were co-expressed in Dil-labeled DRG neurons. (6) Inhibition of p65 attenuated diabetic gastric hypersensitivity and hyper-excitability of gastric-specific DRG neurons. (7) The expression of TRAF6 was significantly up-regulated in diabetic rats. CLI-095 treatment also reduced the expression of TRAF6 and p65. Conclusion: The reduction of microRNA-181a in T7-T10 DRGs might up-regulate TLR4 expression. TLR4 activated NF-κB through MyD88-dependent signaling pathway, increased excitability of gastric-specific DRG neurons, and contributed to diabetic gastric hypersensitivity.