Intragastric Balloon Therapy Research Articles

M1364 Stratification and Prediction of Outcomes of Bariatric Surgery Patients Using the Relative Wellness Index (RWI)

Introduction: intragastric balloons are not commonly used as a therapy for obesity due to concerns about the possible side effects and doubts about effectiveness in long-term. Recent publications suggest a sustained effect on weight loss. In this study we present the results in a non-academic community practice.Methods: All patients who had received an intragastric balloon(BIB) therapy in our hospital and had retained the balloon for at least 3 months were retrospectively evaluated. Succesful therapy was defined as a weight loss ≥ 10 % of weight at baseline. To assess the long-term effects on weight reduction we contacted the patients in whom the balloon was removed for longer than 2 years. Results: 181 patients were treated with an intragastric balloon between January 2002 and September 2009. All balloons were placed and afterwards removed by a gastroenterologist under general anesthesia in day hospital. There were no major complications . 10 balloons were removed during the first month due to intolerance, 2 were spontaneously released and 3 balloons were removed elsewhere. The remaining 166 patients fulfilled the inclusion criteria and were used for the analysis. Mean BMI(body mass index)) at baseline was 34,7(range: 27-52) and mean weight 92 kg (range: 66-140). The balloons were removed after a mean of 7 months (range: 3-23). The mean BMI at removal was 30,1 (range: 19,6-48,5). Mean weight loss was: 11,4 kg (range: 0-33). 102 individuals (61,4 %) had a ≥ 10 % baseline weight loss by time of the balloon removal. 50 patients could be contacted for the long-term evaluation. Mean time after removal was 5,5 years (range: 2-7). 11 patients (22 %) had received bariatric surgery. 16 of the 39 patients(41 %) had retained the weight loss of≥ 10 %. Conclusions: Intragastric balloon therapy was associated with a successfull weight loss at removal in 61,4 %. There were no major complications. In long-term there seems to be a sustained effect in a subgroup of patients . Prospective studies are needed to better define the patients who will benefit from this therapy. 39 patients with long-term results

Single vs Repeated Treatment with the Intragastric Balloon: A 5-Year Weight Loss Study

Saline-filled intragastric balloons (IB) may be inserted for 6 months to promote weight loss. We aimed to assess potential benefits of repeating IB therapy. One hundred eighteen consecutive subjects (median body mass index, 34.0 kg/m(2); interquartile range [IQR], 31.2-36.9) treated with IB were included in a prospective non-randomized multicenter study. Nineteen (16%) subjects had repeat IB therapy at their own request, either to prolong first treatment (n = 8) or after a IB-free interval (n = 11). Higher weight loss 3 months after first IB insertion independently predicted repeat therapy (P = 0.008). Median weight loss in subjects who had repeat therapy was lower with second vs first IB (9.0 vs 14.6 kg; 30.4% vs 49.3% excess weight [EW]; P = 0.003). Compared to subjects with single treatment (n = 99), those with repeat treatment (n = 19) had greater weight loss at first IB extraction (14.6 vs 11.0 kg; 49.3% vs 30.7% EW; P = 0.026) and 1 year later (12.0 vs 6.0 kg; 40.9% vs 20.8% EW; P = 0.008) but the difference became less than 2 kg starting at 3 years. At final follow-up (4.9 years; IQR, 3.4-6.7), the whole subject population had lost a median of 2.0 kg (IQR, -3.0 to 10.3) or 6.2% EW (IQR, -8.1 to 31.6) and identical proportions of subjects with single/repeat treatment had >or=10% baseline weight loss (26%) or bariatric surgery (32%). Higher weight loss at 3 months independently predicted repeat IB therapy; weight loss with the second IB was lower compared to first IB. Repeat treatment had no effect on proportions of subjects with >or=10% baseline weight loss or bariatric surgery at final follow-up.

Re: A complication of intra-gastric balloon therapy.

Re: A complication of intra-gastric balloon therapy.

Intragastrischer Ballon zur Gewichtsreduktion: Ergebnisse bei 100 Patienten nach 2,5 Jahren

Background and study aims: To determine long-term outcome after treatment with an intra-gastric balloon for 6months, with no structured weight maintenance program offered after balloon removal. Patients and methods: 100 consecutive overweight/obese individuals (mean body mass index [BMI] 35.0±5.6kg/ m2) were prospectively fol-lowed after endoscopic implantation of a saline filled intragastric balloon; 97 completed final -follow-up at a mean of 4.8±1.6years. Success-ful intragastric balloon therapy was defined as weight loss at 6 months of ≥ 10% of weight at -baseline, that remained ≥ 10% until 2.5years, with-out bariatric surgery. All analyses followed intention-to-treat principles. Results: At 6months, mean weight loss was 12.6±8.3kg, 63 individuals had ≥ 10% baseline weight loss; no severe morbidity was detected. During the first and second years following intragastric balloon removal, mean body mass in-creased by 4.2±6.8 and 2.3±6.0kg, respectively (P

Intragastric balloon for weight loss: results in 100 individuals followed for at least 2.5 years

To determine long-term outcome after treatment with an intragastric balloon for 6 months, with no structured weight maintenance program offered after balloon removal. 100 consecutive overweight/obese individuals (mean body mass index [BMI] 35.0 +/- 5.6 kg/m (2)) were prospectively followed after endoscopic implantation of a saline-filled intragastric balloon; 97 completed final follow-up at a mean of 4.8 +/- 1.6 years. Successful intragastric balloon therapy was defined as weight loss at 6 months of > or = 10 % of weight at baseline, that remained > or = 10 % until 2.5 years, without bariatric surgery. All analyses followed intention-to-treat principles. At 6 months, mean weight loss was 12.6 +/- 8.3 kg, 63 individuals had > or = 10 % baseline weight loss; no severe morbidity was detected. During the first and second years following intragastric balloon removal, mean body mass increased by 4.2 +/- 6.8 and 2.3 +/- 6.0 kg, respectively ( P < 0.001 for both year-on-year comparisons). At 2.5 years, intragastric balloon therapy had been successful in 24 participants. At final follow-up (4.8 +/- 1.6 years), 28 had > or = 10 % baseline weight loss, 35 had undergone bariatric surgery (60 % had preoperative mass higher than baseline), and 3 were lost to follow-up; the 34 remaining had lost 1.5 +/- 5.8 kg compared with baseline. During follow-up, 13 had a second intragastric balloon implanted and 13 took sibutramine for short periods. Intragastric balloon therapy was relatively innocuous and associated with successful weight loss and maintenance at 2.5 years in a quarter of participants. It represents a valid option for weight loss.

Intragastric Balloon Followed by Biliopancreatic Diversion in a Liver Transplant Recipient: A Case Report

Liver transplantation is a life-saving procedure for end-stage liver disease. In liver transplant recipients, morbid obesity influences post-operative survival and graft function. In 1996, our patient underwent a successful liver transplantation because of a HCV-related liver failure (body mass index (BMI) 31). Follow-up showed a functional graft and the development of severe obesity up to a BMI of 61 in January 2006. In January 2007, he was submitted to intragastric balloon therapy for 6 months, reaching a BMI of 54. In September 2007, he underwent a biliopancreatic diversion. During follow-up to March 2008, he reached a BMI of 42 with ameliorations of comorbidities. In May 2008, during a hospital admission, he suddenly died of a heart attack. Post mortem study revealed a myocardial infarction. This is the first world case report for this approach. According to our opinion, patient's death was not related to bariatric surgery.

Laparoscopic sleeve gastrectomy versus intragastric balloon: a case-control study

To compare the efficacy of laparoscopic sleeve gastrectomy (LSG) and BioEnterics intragastric balloon (BIB) to lose weight and comorbidities after 12 months of follow-up before a more invasive bariatric procedure. From January 2004 to December 2006, 40 patients underwent laparoscopic sleeve gastrectomy (LSG) as a first step in biliopancreatic diversion with duodenal switch. Controls (n = 80) were selected based on charts of patients who, during the same period, underwent BioEnterics intragastric balloon therapy. In both groups we considered: length of procedure, hospital stay, intraoperative or endoscopic complications, postoperative or postendoscopic complications, comorbidities at baseline, after 6 months (time of BIB removal), and after 12 months from baseline, and weight loss parameters [weight in kg, percentage excess weight less (%EWL), body mass index (BMI), and percentage excess BMI loss (%EBL)]. Results are expressed as mean +/- standard deviation. Mortality, intra- and postoperative complications (in LSG group), and intra- and postendoscopic complications (in BIB group) were absent. Mean operative time in the LSG group was 120 +/- 40 (range 60-200) min. Mean positioning time for BIB was 15 +/- 5 (range 10-25) min. BMI at baseline was 54.1 +/- 2.9 (range 45.1-55.9) kg/m(2) and 54.8 +/- 2.5 (range 45.1-56.2) kg/m(2) in BIB and LSG groups, respectively. At 6-month follow-up, mean BMI was 46.2 +/- 3.5 and 45.3 +/- 5.5 kg/m(2) in the BIB and LSG patients, respectively [p = not significant (ns)]. After 12 months BIB patients regained BMI, even if strictly followed with a diet regimen, while LSG patients continued to lose weight. Significant differences between groups were absent for the comorbidities considered. Laparoscopic sleeve gastrectomy and BioEnterics intragastric balloon are two valid options for producing weight loss as a first-step procedure. LSG has all the related risks of general anesthesia, laparoscopic surgery, and digestive anastomosis, whereas BIB presents a very low rate of minor complications, such as psychological intolerance. For all these reasons, at this time, BIB is considered a better option than LSG as a first-step procedure in the short term (12 months).

A case of asymptomatic fungal and bacterial colonization ofan intragastric balloon

Intragastric balloon therapy, as a part of a multidisciplinary weight management program, is an effective short-term intervention for weight loss. Although the insertion procedure is easy and generally well tolerated by patients, a few complications can occur. We report here a heavy smoker with intragastric balloon insertion complicated by colonization with opportunistic organisms. The 27-year-old female, body mass index 35.5 kg/m(2), had a BioEnterics Intragastric Balloon inserted under conscious sedation without any perioperative complications. Six months later, when the standard removal time arrived, the balloon was seen to be covered with a necrotic white-gray material. Microbiological examination revealed Enterobacter cloacae and Candida species yeast colonies. We recommend that asymptomatic fungal and/or bacterial colonization should be considered among the complications of the intragastric balloon procedure, despite its rarity.

Intra-gastric balloon therapy and weight reduction

Intra-gastric (TBT) can achieve pre-operative weight loss in obese patients, and may make surgery safer and easier. We report our experience in weight reduction and outcome in morbidly obese patients. Data were prospectively collected in 50 consecutive morbidly obese patients undergoing intra-gastric balloon therapy. All balloons were inserted and removed by one consultant operator and injected with 500-600 mls of methylene blue-stained saline. Patients were admitted after balloon insertion to control nausea and reflux symptoms. Analysis was performed on post-insertion data collated from the hospital obesity database and patient note review. The majority of patients (70%) were female. Prior to IBT, mean patient weight was 149.9 +/- 36.8 kg (male 184.7 +/- 38.1 kg, female 135 +/- 26.5 kg). At six months follow-up, mean weight of patients reduced to 133.5 +/- 34.3kg (male 166.8 +/- 33.3 kg, female 119.3 +/- 25.9 kg). The overall percentage of excess weight loss was 22% (male 17%, female 25%, p=NS). Mean patient body mass index (BMI) at balloon insertion was 52.8 (+/-8.2) kg/m2 (male 56.8, female 51.0), mean patient BMI reduced to 47 (+/-8.1) (males 51.4, females 45.1) at six months. Average BMI loss was 5.8 (male 5.4, female 6.0). IBT is an effective method of weight reduction in morbid obesity with an average excess weight loss of 22% in this series. The benefit of pre-operative weight loss in this patient group is likely to be significant, but has yet to be measured.

About intragastric balloon therapy in connection with treatment of morbid obese elderly patient. Case report

Introduction: the intragastric balloon therapy is a special endoscopic technique, transitional between conservative and surgical therapy of pathological obesity. When conservative therapy fails and surgical intervention is too risky, the intragastric balloon therapy is considered to be accepted is many countries of the world.

Use of intragastric balloons for weight reduction: An experimental study

The effect of intragastric balloons as a noninvasive method for weight reduction was observed in nine castrated Yorkshire pigs. None of the animals lost weight. The appetites of the experimental animals were inhibited for only a short period of time. A significant dilatation of the stomach after balloon insertion was noted which resulted from increased food intake and obliterated the effect of the intragastric balloons. A long-standing lower blood glucose level played an important role in the increments in food intake and dilatation of the stomach. At the same time, ulceration was seen in 83.3 percent of the animals that received balloons. We conclude that intragastric balloon therapy may not be an effective approach for managing morbid obesity in human subjects.