Intragastric Balloon Group Research Articles

Weight-Loss Endoscopy Trial: A Multicenter, Randomized, Controlled Trial Comparing Weight Loss in Endoscopically Implanted Duodenal-Jejunal Bypass Liners versus Intragastric Balloons versus a Sham Procedure.

Obesity is associated with reduced life expectancy and various comorbidities. Surgical interventions are effective but accompanied by the risk of serious complications. Less invasive endoscopic procedures mainly comprise the intragastric balloon (IB) and the duodenal-jejunal bypass liner (DJBL). A randomized, sham-controlled study comparing both procedures has not been undertaken so far. We performed a randomized, patient- and assessor-blinded, controlled trial comparing weight loss in IB versus DJBL versus a sham procedure (2:2:1 ratio). Patients with a BMI >35 kg/m2 or >30 with obesity-related comorbidities were included. The IB was removed after 6 months and the DJBL after 12 months. The main objective was successful weight loss (>10% from baseline) 12 months after explantation of the devices. Secondary outcomes were changes in comorbidities, quality of life, and complications. Thirty-three patients were randomized. Recruitment has to be stopped suddenly in after the DJBL device lost its CE mark in Europe. In all, 11 patients received DJBL, 15 IB, and 7 were allocated to the sham group. Blinding was feasible in all patients. Weight decreased from baseline until explantation (DJBL: 129.4 ± 28.3 kg to 107.4 ± 16.7 kg; IB: 118.3 ± 22.8 kg to 107.4 ± 25.7 kg; sham: 134.6 ± 18.0 kg to 131.2 ± 14.3 kg), but patients regained weight almost to the baseline level 12 months after explantation. Only 1 patient in IB group reached the primary endpoint. Severe device-related complications were very rare. Endoscopic bariatric procedures failed to achieve effective weight loss 12 months after explantation of the devices. The results of this trial need to be interpreted with caution due to its early termination.

Sleeve gastrectomy versus endoscopic intragastric balloon in decreasing weight and associated comorbidities in Erbil city: A comparative study

Background: Surgical obesity treatment is difficult for both surgeons and patients. The three main categories of bariatric surgery procedures are malabsorptive, restrictive, or both in combination. Intragastric balloon (IB) is an easily applicable restrictive interventional and nonsurgical strategy for obese patients, and the surgical procedure known as laparoscopic sleeve gastrectomy (LSG) is frequently used to help obese patients decrease weight.
 Objective: To assess and compare these two restrictive approaches.
 Patients and Methods: A prospective study of 138 LSG patients was conducted, (n=82) and IB (n=56) between 1st January 2016 to 31st December 2021 in private hospitals in Erbil, Iraq. The study retrospectively evaluates patients' demographic information, changes in total body weight (TBW), changes in body mass index (BMI), and percentage of excess weight loss (%EWL), morbidities and change of comorbidities during a year of follow-up, at months 1, 3, 6, and 12 after surgery. Comparative analysis was undertaken for the follow-up results after 6 and 12 months.
 Results: In the IB group, 12 patients did not tolerate insertion, leaving 56; in the LSG group, 82 patients completed treatment. In terms of age (p=0.121), gender (p=0.242), and BMI (p=0.078), there were no statistical differences between the IB and LSG groups. The LSG group achieved statistically significant superior treatment outcomes in terms of changes in TBW, BMI, and %EWL.
 Conclusion: Both LSG and IB are beneficial in the short term for helping obese patients lose weight. IB has the benefit of being performed as an outpatient procedure with less complications, but it is less successful in helping people lose weight than LSG. The best options for various patient groups in terms of clinical outcomes and health system effectiveness must be determined through prospective, randomized control studies.

Sleeve gastrectomy versus endoscopic intragastric balloon in decreasing weight and associated comorbidities in Erbil city: A comparative study

Background: Surgical obesity treatment is difficult for both surgeons and patients. The three main categories of bariatric surgery procedures are malabsorptive, restrictive, or both in combination. Intragastric balloon (IB) is an easily applicable restrictive interventional and nonsurgical strategy for obese patients, and the surgical procedure known as laparoscopic sleeve gastrectomy (LSG) is frequently used to help obese patients decrease weight. Objective: To assess and compare these two restrictive approaches. Patients and Methods: A prospective study of 138 LSG patients was conducted, (n=82) and IB (n=56) between 1st January 2016 to 31st December 2021 in private hospitals in Erbil, Iraq. The study retrospectively evaluates patients' demographic information, changes in total body weight (TBW), changes in body mass index (BMI), and percentage of excess weight loss (%EWL), morbidities and change of comorbidities during a year of follow-up, at months 1, 3, 6, and 12 after surgery. Comparative analysis was undertaken for the follow-up results after 6 and 12 months. Results: In the IB group, 12 patients did not tolerate insertion, leaving 56; in the LSG group, 82 patients completed treatment. In terms of age (p=0.121), gender (p=0.242), and BMI (p=0.078), there were no statistical differences between the IB and LSG groups. The LSG group achieved statistically significant superior treatment outcomes in terms of changes in TBW, BMI, and %EWL. Conclusion: Both LSG and IB are beneficial in the short term for helping obese patients lose weight. IB has the benefit of being performed as an outpatient procedure with less complications, but it is less successful in helping people lose weight than LSG. The best options for various patient groups in terms of clinical outcomes and health system effectiveness must be determined through prospective, randomized control studies.

Intra-gastric balloon with lifestyle modification: a promising therapeutic option for overweight and obese patients with metabolic dysfunction-associated steatotic liver disease

BackgroundData on effects of intra-gastric balloon (IGB) on metabolic dysfunction-associated steatotic liver disease (MASLD) are scarce, in part with contradictory results, and mainly obtained in tertiary care patients with diabetes and other comorbidities. We here explore effects of IGB in patients with MASLD referred to a first-line obesity clinic.MethodsIn this prospective cohort study, patients with at least significant fibrosis (≥ F2) and/or severe steatosis (S3) according to screening transient elastography (FibroScan®) were offered a second FibroScan® after 6 months lifestyle modification with or without IGB (based on patient preference). Results: 50 of 100 consecutively screened patients (generally non-diabetic) qualified for repeated evaluation and 29 (58%) of those had a second FibroScan®. At baseline, at least significant fibrosis was present in 28% and severe steatosis in 91%. IGB was placed in 19 patients (59%), whereas 10 patients (41%) preferred only lifestyle modification (no differences in baseline characteristics between both groups). After 6 months, liver stiffness decreased markedly in the IGB group (median: from 6.0 to 4.9 kPa, p = 0.005), but not in the lifestyle modification only group (median: from 5.5 to 6.9 kPa, p = 0.477). Steatosis improved in both groups, (controlled attenuation parameter values; IGB, mean ± SD: from 328 ± 34 to 272 ± 62 dB/m, p = 0.006: lifestyle modification only, mean ± SD: from 344 ± 33 to 305 ± 43 dB/m: p = 0.006).ConclusionBoth steatosis and fibrosis improve markedly in overweight/obese patients with MASLD after 6 months IGB combined with lifestyle modification. Our results warrant further research into long-term effect of IGB in these patients.

Efficacy of Intragastric Balloon versus Liraglutide as Bridge to Surgery in Super-Obese Patients

Introduction: Bariatric surgery is a safe and effective treatment for obesity, although in super-obese patients (BMI ≥50 kg/m²) it can become challenging for anatomical and anesthesiologic issues. Several bridging therapies have been proposed to increase preoperative weight loss and decrease perioperative morbidity and mortality. The aim of this study was to compare the efficacy and safety of different two-stage approaches in super-obese patients: laparoscopic sleeve gastrectomy (LSG) following preoperative liraglutide therapy versus LSG with preoperative intragastric balloon (IGB) during a 1-year follow-up. Methods: Clinical records of 86 patients affected by super-obesity who underwent two-stage approach between January 2019 and January 2022 were retrospectively reviewed using a prospectively maintained database. Patients were separated into two groups: those managed with preoperative IGB and those with liraglutide 3.0 mg prior to LSG. Weight (kg), BMI (kg/m²), %EWL, and %EBWL were reported and compared between the two groups at the end of bridging therapy, at 6th month and 12th month postoperatively. Postoperative complications were recorded. Results: Forty-four patients underwent IGB insertion prior to LSG, while 42 were treated with liraglutide. There were no statistical differences in baseline weight and BMI. At the end of preoperative treatment, the group treated with IGB reported a significant reduction in BMI (47.24 kg/m² vs. 53.6 kg/m²; p < 0.391) compared to liraglutide group. There were no differences recorded between the two groups concerning postoperative complications. At 6 months, the liraglutide group had lower %EWL (15.8 vs. 29.84; p < 0.05) and %EBWL (27.8 vs. 55.6; p < 0.05) when compared to IGB group. At 12 months, the IGB preserved with higher %EWL (39.9 vs. 25; p < 0.05) and %EBWL (71.2 vs. 42; p < 0.05). Conclusion: A two-stage therapeutic approach with IGB prior to LSG in super-obese patients could be considered an attractive alternative to liraglutide as bridging therapy before bariatric surgery.

İntragastrik Balon ve Botulinum Toksin Enjeksiyonunun Kilo Kaybı Üzerine Kısa Dönem Etkilerinin Karşılaştırılması

Aim: To compare the effects of endoscopic intragastric balloon (IGB) placement and intragastric botulinum toxin-A (BTX-A) injection in terms of weight loss among patients with non-morbid obesity. Methods: This retrospective single center study was conducted between 01.08.2020 and 01.01.2022. A total of 39 patients with a body mass index (BMI) of &amp;lt;40 without comorbidities were included in the study. Nineteen underwent intragastric BTX-A injection and 20 underwent IGB placement. Patients were evaluated 1 month and 6 months after the procedures. Results: Mean age was 39.4 ± 8.6 in the BTX-A group and 37.3 ± 10.4 in the IGB group (p = 0.496). 78.9% of the BTX-A group and 75.0% of the IGB group were female (p = 1.000). In both groups, the median weight 1 month after the procedure was significantly lower than before the procedure, and the median weight 6 months after the procedure was significantly lower than 1 month after the procedure (p&amp;lt;0.001 for both groups). The median weight loss in the IGB group at both the 1st and 6th months was significantly greater than the corresponding values of the BTX-A group (p &amp;lt; 0.001 for both). Conclusion: IGB insertion appears to be a more successful endoscopic bariatric procedure than intragastric BTX-A injection, as measured by weight loss at post-intervention 1 month and 6 months. IGB may be preferred in patients with a BMI below 40 without obesity-related comorbidity.

Efficacy and Safety of Intragastric Balloon Therapy Compared to a Multidisciplinary Weight Loss Program (OPTIFAST) in a Real-World Population: A Propensity Score Matching Analysis

Introduction: Obesity is a major global health problem associated with comorbidities such as diabetes, cardiovascular disease, and cancer. Bariatric surgery is recognized to be the most effective weight loss intervention, but it is highly invasive and costly and can have serious side effects. Intragastric balloon (IGB) placement by endoscopy and hypocaloric diets are among a number of techniques that have been used in patients unsuitable for, or unwilling to undergo, obesity surgery. In this study, we compared the efficacy, safety, and cost-effectiveness of the hypocaloric OPTIFAST program (OPT) with endoscopic IGB placement for weight loss. Methods: In this retrospective observational cohort propensity score-weighted comparison (performed May 2014 to December 2020), participants with a BMI of 30–55 kg/m2, aged 18–70 years, were randomized to OPT or IGB for 26 weeks, followed by a weight maintenance phase. Patients were matched according to age, gender, and BMI. The study outcomes were percentage excess body weight lost, total body weight lost (TBWL), and percentage TBWL (%TBWL). Results: A total of 148 participants (75% of those randomized; 74 OPT, 74 IGB) made up the ITT population. Mean age was 44.1 ± 10.4 years, and the patients were predominantly female (77%). Baseline BMI was 44.1 ± 10.4 kg/m2. At 26 weeks, %TBWL in the OPT group was 19.6 ± 6.8% versus 11.9 ± 6.7% for IGB (p < 0.001). At 52 weeks, %TBWL for OPT was 18.2 ± 9.0% versus 12.0 ± 6.6% for IGB (p < 0.001). The OPT cohort also experienced significantly fewer adverse events compared with the IGB group. Conclusion: IGB placement and OPT induce clinically meaningful weight loss. However, OPT appears to induce clinically superior weight loss and has economic advantages through lower rates of complications and adverse events.

Impact of Intragastric Balloon Placement on the Stomach Wall: A Prospective Cohort Study.

Endoscopic intragastric balloon (IGB) placement is a minimally invasive treatment for morbid obesity that is sometimes used as a preparatory step before surgical intervention. This study was performed to analyze the changes in the stomach wall induced by IGB placement, with particular emphasis on pathomorphology, inflammatory markers, and tissue growth factors. In total, 30 patients with morbid obesity were prospectively analyzed. A total of 16 patients with body mass index (BMI) ≥ 53kg/m2 underwent two-stage treatment comprising IGB placement followed by laparoscopic sleeve gastrectomy (LSG) (IGB group), while 14 patients underwent one-stage LSG (non-IGB group). The gastric specimens removed during LSG were examined. The two groups were compared regarding the surgical results, microscopic structure and inflammatory process exponents of the stomach wall, and receptors for selected tissue growth factors. The IGB group had a longer median hospital stay than that of the non-IGB group. Compared with the non-IGB group, the IGB group had a thicker stomach wall, more submucosal fibrosis, and increased amounts of growth factors and inflammatory markers. Patients with IGB placement before LSG showed greater changes in the stomach wall than those of patients who received LSG alone. IGB placement was associated with stomach muscle layer thickening, submucosal fibrosis, and increased levels of inflammatory markers and tissue growth factors.

Outcomes with Intra-gastric Balloon Therapy in BMI < 35 Non-morbid Obesity: 10-Year Follow-Up Study of an RCT.

Intra-gastric balloon (IGB) therapy is the most established endoscopic treatment of obesity, but there is a paucity of literature on long-term efficacy. This study aims to evaluate the short- and long-term weight loss efficacy of IGB. Double-blinded RCT with 6-month IGB vs with sham endoscopy, in body mass index (BMI) 27-35 patients. Anthropometric, fasting glucose, and lipid profile measurement as early outcomes (up to 2years) and 10-year follow-up. Primary outcomes were total body weight loss (kg) and BMI. Secondary outcomes were new-onset diabetes mellitus, other new comorbidities, and willingness for further intervention. Initial RCT recruited 99 patients (50 IGB vs 49 sibutramine group). Forty-nine patients (26 IGB vs 23 control group) participated in a 10-year review (follow-up rate of 51.6%). Total body weight loss at 6 (9.75 vs 7.48kg, p = 0.03), 12 (6.52 vs 4.42kg, p = 0.05), 18 (5.42 vs 3.57, p = 0.32), and 24months (4.07 vs 2.93kg, p = 0.56) favored the IGB group. Total weight loss (TWL) at 10years (0.03 vs - 2.32kg, p = 0.05) and %TWL (- 0.16 ± 12.8% vs - 2.84 ± 5.6%, p = 0.39) were not significantly different between groups. Follow-up BMI (30.97 ± 1.6 vs 30.38 ± 1.8kg/m2, p = 1.00) was similar. At 10years, new-onset diabetes mellitus, sleep apnoea, metabolic syndrome, and arthralgia were not significant (p > 0.05). Twenty-three (81%) IGB group vs 13 (56%) control expressed a willingness for further intervention (p < 0.01). IGB delivers weight loss to 2years and is superior to control. However, new comorbidity development is not significantly different at 10years. Patient that received IGB therapy were subsequently more willing for further bariatric metabolic intervention.

Intragastric Balloon Treatment for Obesity: Review of Recent Studies.

The FDA recently approved three intragastric balloon (IGB) devices, ReShape, ORBERA™, and Obalon for treatment of 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. This review focused on eight recent (2006-present) randomized controlled trials (RCTs) comparing percentage total body weight loss (%TBWL) between IGB and control groups including three reviewed by the FDA. %TBWL based on the reviewed studies was also compared with bariatric surgery and pharmacotherapy. Of the eight IGB studies, five had balloon treatment duration of 6 months. Efficacy at 6 months, based on a pooled weighted-mean %TBWL, was 9.7%, and the control-subtracted %TBWL was 5.6%. When one study without SDs was removed, the weighted mean %TBWL was 9.3±5.7% SD, and control-subtracted %TBWL was 5.5±7.8%, which was statistically greater than controls. IGB showed lower efficacy than bariatric surgery (median weight loss of 27% for Rouen-Y gastric bypass (RYGB). The control-subtracted %TBWL over 6months of 5.5-5.6% is less than the most efficacious FDA-approved weight loss drug, Qsymia. At the recommended dose, Qsymia has a placebo-subtracted %TBWL at 6 months of approximately 6.6%. The weighted mean reported incidence of serious adverse events (SAEs) in the IGB group across all eight studies was 10.5%. Only six of the eight reviewed studies reported adverse events (AEs) in the IGB group, with a pooled reported incidence of 28.2%. Recently, the FDA reported new AEs including acute pancreatitis with ReShape and ORBERA™. Based on the available evidence, it is unlikely that IGB use will supplant other forms of obesity treatment. The estimated cost of endoscopic balloon implantation and retrieval is US $8,150. Collectively, a relatively small control-subtracted %TBWL and the potential for serious complications makes IGB unlikely to become widely adopted. Given the recent FDA warning, IGB longevity on the market is questionable.

Impact of Intragastric Balloon Before Laparoscopic Gastric Bypass on Patients with Super Obesity: a Randomized Multicenter Study.

Super obese patients are recommended to lose weight before bariatric surgery. The effect of intragastric balloon (IGB)-induced weight loss before laparoscopic gastric bypass (LGBP) has not been reported. The aim of this prospective randomized multicenter study was to compare the impact of preoperative 6-month IGB with standard medical care (SMC) in LGBP patients. Patients with BMI >45kg/m2 selected for LGBP were included and randomized to receive either SMC or IGB. After 6months (M6), the IGB was removed and LGBP was performed in both groups. Postoperative follow-up period was 6months (M12). The primary endpoint was the proportion of patients requiring ICU stay >24h; secondary criteria were weight changes, operative time, hospitalization stay, and perioperative complications. Only 115 patients were included (BMI 54.3±8.7kg/m2), of which 55 underwent IGB insertion. The proportion of patients who stayed in ICU >24h was similar in both groups (P=0.87). At M6, weight loss was significantly greater in the IGB group than in the SMC group (P<0.0001). Three severe complications occurred during IGB removal. Mean operative time for LGBP was similar in both groups (P=0.49). Five patients had 1 or more surgical complications, all in the IGB group (P=0.02). Both groups had similar hospitalization stay (P=0.59) and weight loss at M12 (P=0.31). IGB insertion before LGBP induced weight loss but did not improve the perioperative outcomes or affect postoperative weight loss.

Delayed gastric emptying as a proposed mechanism of action during intragastric balloon therapy: Results of a prospective study.

The effects of intragastric balloon (IGB) therapy on gastric emptying (GE) and weight loss remain to be fully understood. The effects of IGB on GE were investigated in this study. This was a single-center, randomized, controlled study in which subjects with obesity either underwent IGB placement or were matched controls. IGB was removed at 6 months. GE was measured at baseline and at weeks 0, 8, 16, 27, and 39. Percent total body weight loss (%TBWL) was measured at 6 and 12 months. Twenty-nine subjects with obesity were enrolled; 15 were randomized to IGB placement and 14 to control. Two subjects had the IGB removed early. At baseline, 1- and 2-h gastric retention values were comparable between the groups but increased in the IGB group at weeks 8 and 16 (during IGB treatment) and then returned to baseline levels at 27 and 39 weeks. A greater increase in gastric retention from baseline to 8 weeks was associated with higher %TBWL. GE in subjects with IGB is delayed but returns to normal after IGB removal. Greater changes in increased gastric retention were associated with greater %TBWL. Altering gastric motility is a significant mechanism of action by which the IGB results in weight loss.

Smoking Habit in Severe Obese after bariatric procedures.

BackgroundBariatric procedures provide an effective means of short term weight loss and sustained weight control for the morbidly obese. The effect of bariatric procedures on smoking habit in obese subjects is not well known. Therefore, we examined the short term effect of bariatric surgery on smoking habit of severe obese patients up to 12 months from the intervention.Patients and MethodsSmoking habit was assessed in a cohort of 78 morbid smoking obese patients followed at our clinic for bariatric procedures. They underwent non surgical intra-gastric balloon (IB) or surgical procedures such as lap–band laparoscopic surgery (LAGB) or sleeve gastrectomy/gastric by-pass (SPG). Subjects were administered a written questionnaire about their smoking habit before and 3, 6 and 12 months after the procedures.ResultsNo differences were found among the three groups at 6 and 12 months after the procedures (IB 21 %, LAGB 6 %, SPG 5 %; and IB 14 %, LAGB 3 %, SPG 5 %). Only after 3 months, the rate of quitting of the IB group was higher than LAGB and SPG groups (36 %, 6 % and 5 %, respectively; p = 0.02).ConclusionsBariatric procedures have no effects on smoking habit of moderate-to-heavy smoker severe obese patients. The use of other traditional smoking cessation methods in patients undergone to bariatric procedures should be implemented.

Multicenter Randomized Study of Obesity Treatment with Minimally Invasive Injection of Hyaluronic Acid Versus and Combined with Intragastric Balloon.

Research into minimally invasive techniques is worthwhile for greater acceptance in bariatric surgery, a useful first step being to evaluate the combination of these with current procedures. We suggest that intragastric balloon (IGB) can be performed with hyaluronic acid (HA) injections at the level of the gastroesophageal junction. A submucosal restriction is created by circular injection of an absorbable material within a defined area based on endoscopic anatomy. We included 101 patients in a prospective multicenter randomized trial, with average body mass index (BMI) 33.4 (range 27-44), treated from April 2010 to April 2012 by IGB and/or HA injection, sequentially, and followed for two more years. Patients were divided into group 1 (IGB alone), group 2 (IGB followed by HA at IGB removal, at 6months), and group 3 (HA and IGB at 6months). BMI loss at 6months was inferior in the HA group (32 patients) compared with the IGB groups (68 patients) (2.1 ± 0.4 versus 3.4 ± 0.3, p < 0.05). The efficacy of IGB alone compared with combined treatments (groups 2 and 3) was significantly inferior at 18months only, but the impact of the treatment sequence (HA before or after IGB) on BMI loss was not statistically significant, although in favor of HA first. This study did not demonstrate the efficacy of HA injections as an obesity treatment.

Comparison of Short-Term Results of Laparoscopic Gastric Plication and Intragastric Balloon

Introduction: Management of obesity is difficult problem for doctors and patients. There are many methods for dealing with obesity. Intragastric Balloon (IB) is interventional and nonsurgical way of promoting weight loss in obese patients. Laparoscopic Gastric Plication (LGP) is most physiologic surgical method of bariatric surgery. This study aimed to evaluate and compare these two restrictive methods. Methods: Ninety-five obese patients (34 male and 61 female) included in this study. We compared patients treated with IB (n=52) and LGP (n=43). Data on patient demography, change in Body Mass Index (BMI) and %excess weight loss (%EWL) of 1st and 6th months were collected. Results: The study had started with 69 patients for IB group, but 4 (5.7%) of them did not tolerate the insertion and 13 had removed the balloon early after insertion (n=13 (20%)) were excluded from the study. There were 52 patients left in IB group and 43 patients in plication group. There were no statistically difference between IB and plication groups in terms of age (p=0.132), sex (p=0.262) and BMI (p=0.081). Change in total body weight (TBW), BMI and %excessive weight loss (EWL) parameters were statistically different in favor of the plication group. Conclusion: Our clinical experience has suggested that LGP and IB are effective in loss of weight in obese patients in short term. IB has an advantage of being done outpatient and has fewer complications, but it is less effective on weight loss compared to LGP. Prospective, randomized control trials are needed to choose best way.

An intragastric balloon produces large weight losses in the absence of a change in ghrelin or peptide YY

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT?: The development of obesity is a multi-factorial process that results in an alteration in the neuroendocrine hormones that help regulate appetite and body weight. Weight loss has been shown to alter this neuroendocrine balance so as to promote weight regain. An intragastric balloon is an effective method to achieve significant weight loss in obese patients and is well suited for those patients who are looking for an alternative to lifestyle modification alone, and those who are not ready or suitable for surgical intervention. Limited research has shown that the weight loss achieved with an intragastric balloon is mediated by altered secretion of the hormones that regulate appetite and weight. WHAT DOES THIS STUDY ADD?: There are currently limited data on the effects of intragastric balloons on appetite and weight-related hormones. In the current study, we have investigated a broad range of gut hormones and adipokines and their response to weight loss induced by differing methods, and the subsequent effect this may have on weight regain. This is an important research area as novel therapies and long-term strategies are needed to counteract the unfavourable changes to the neuroendocrine control of appetite and satiety associated with diet-induced weight loss. This study aims to determine the effect of weight loss achieved with different methods on fasting levels of appetite hormones. Sixty-six obese adults with metabolic syndrome were randomized to intragastric balloon (IGB) for 6 months, with a 12-month behavioural modification programme (IGB group, 'IGBG') or a 12-month behavioural modification programme alone (control group, 'CG'). Anthropometric assessments and blood samples were taken every 3 months and total ghrelin, peptide YY (PYY), adiponectin and leptin were measured. Significant weight-loss differences favouring the IGBG were evident between groups at all time points. Ghrelin increased when the IGB was in situ (+39.3 pmol L(-1) vs. baseline) and returned to baseline after its removal (-34.7 pmol L(-1) ). Adiponectin and PYY levels remained stable in the IGBG, with transient increases noted in the CG. There were no significant between-group differences for ghrelin, PYY or adiponectin. In the IGBG, despite a decrease in leptin at 6 months (-11.7 ng mL(-1) ), levels increased to baseline after IGB removal (-3.7 ng mL(-1) ). In summary, weight loss associated with the IGB did not alter fasting levels of PYY or adiponectin. There was a return of ghrelin and leptin levels to baseline values after IGB removal. No compensatory rise in ghrelin was evident in either group 12 months after initial weight reduction, suggesting that such treatment strategies may lead to better long-term sustainable weight loss.

Preoperative Weight Loss with Intragastric Balloon Decreases the Risk of Significant Adverse Outcomes of Laparoscopic Gastric Bypass in Super-Super Obese Patients

Extreme obesity increases morbi-mortality in bariatric surgery. We previously showed that significant weight loss can be obtained within 3 months in super-super obese patients (BMI > 60 kg/m(2)) with an intragastric balloon (IGB). Here, we explored the potential benefit of preoperative IGB on the outcome of laparoscopic gastric bypass (LGBP) in super-super obese patients. In this case-control study, we compared the records of 60 consecutive super-super obese patients (66.5 ± 3.4 kg/m(2)) submitted to a LGBP between 2004 and 2009, with preoperative IGB (n = 23, cases) or without (n = 37, controls). We analyzed the clinical outcome of surgery and a composite end point of significant adverse events defined as the presence of at least one of the following conditions: conversion to laparotomy, intensive care unit stay for more than 2 days, and overall hospital stay superior to 2 weeks. All baseline clinical and biological characteristics were homogenous between both groups. IGB was maintained during 155 ± 62 days and induced a loss of 5.5 ± 1.3 kg/m(2) (11.2 ± 3.2% of excess body mass index) at the time of LGBP, associated with a decrease in systolic blood pressure and gamma-glutamyl transpeptidase level (p < 0.05 vs. baseline). Operative time was lower in the IGB group (146 ± 47 vs. 201 ± 81 min in controls; p < 0.01). Significant adverse events occurred less frequently after LGBP in the IGB group (2 vs. 13 in controls; p < 0.05). All patients were alive at 1 year and overall weight loss was similar in both groups (52.4 ± 17.3 vs. 50.3 ± 12.7 percent of excess BMI loss in controls; NS). IGB prior to LGBP in super-super obese patients significantly reduced excess BMI. It was associated with a shorter operative time and a lower overall risk of significant adverse outcomes.

Preoperative weight loss in patients with indication of bariatric surgery: which is the best method?

Surgery is the only effective treatment for people with a body mass index (BMI) greater than 40 Kg/m² or even greater than 35 Kg/m² when some diseases like diabetes or hypertension appear. In order to minimize surgical risk and improve postoperative results, preoperative preparation it's very important. "Acute" preoperative weight loss just before surgery plays a crucial role in that preparation and can be achieved through different ways like a low calorie diet, a very low calorie diet or with the use of an intragastric balloon. The advantages or particularities of every one of them will be summarized in this article. Literature review of the benefits, risks and complications of preoperative weight loss through a low calorie diet, a very low calorie diet or intragastric balloon placement. Seven of thirteen initially selected reports from Medline search were considered relevant, including a total 371 patients (240 patients treated with low calorie diet, 90 with very low calorie diet and 41 cases of intragastric balloon placement). We found that weight loss was greater in patients with very low calorie diets and intragastric balloon groups but with a slightly increase in morbidity and cost. Although there are no comparative studies, data from the literature results show that diets very low in calories are more effective and require less time than low-calorie diets and cheaper with fewer side effects than the intragastric balloon.

PÉRDIDA DE PESO PREOPERATORIA EN PACIENTES CON INDICACIÓN DE CIRUGÍA BARIATRICA: ¿QUÉ MÉTODO ES MEJOR?

Background: Surgery is the only effective treatment for people with a body mass index (BMI) greater than 40 Kg/m2 or even greater than 35 Kg/m2 when some diseases like diabetes or hypertension appear. In order to minimize surgical risk and improve postoperative results, preoperative preparation it’s very important. “Acute” preoperative weight loss just before surgery plays a crucial role in that preparation and can be achieved through different ways like a low calorie diet, a very low calorie diet or with the use of an intragastric balloon. The advantages or particularities of every one of them will be summarized in this article. Material and methods: Literature review of the benefits, risks and complications of preoperative weight loss through a low calorie diet, a very low calorie diet or intragastric balloon placement. Results: Seven of thirteen initially selected reports from Medline search were considered relevant, including a total 371 patients (240 patients treated with low calorie diet, 90 with very low calorie diet and 41 cases of intragastric balloon placement). We found that weight loss was greater in patients with very low calorie diets and intragastric balloon groups but with a slightly increase in morbidity and cost. Conclusion: Although there are no comparative studies, data from the literature results show that diets very low in calories are more effective and require less time than low-calorie diets and cheaper with fewer side effects than the intragastric balloon.

Comparison of Results of Laparoscopic Gastric Banding and Consecutive Intragastric Balloon Application at 18 Months: A Clinical Prospective Study

Obesity is a serious health problem that leads to serious physical and psychological problems. The methods used in treating obesity include diet and behavioral changes, pharmacotherapy, and surgery. Laparoscopic adjustable gastric banding (LAGB) and intragastric balloon (IGB) applications are two of the methods used to treat obesity. The aim of this study was to compare the effects of LAGB with those of two consecutive IGB applications in weight loss management of obese patients. Thirty-two patients (F/M:24/8) admitted in the study were divided into two groups. In the first group of 16 patients, LAGB was performed, and in the other group two consecutive IGBs were applied. Total weight loss, body mass index (BMI), excess weight loss percent (EWL %), and excess body mass index loss percent (EBMIL %) were recorded at months 6, 12, and 18 for both groups. At the end of the 6th month, BMI values of LAGB and IGB groups were 36.0 and 30.6 kg/m(2), EWL % were 32.3% and 39.3%, and EBMIL % were 36.3% and 47.1%, respectively. The results were similar. At the end of 12 months, median BMI was 36.6 kg/m(2) for LAGB and 27.5 kg/m(2) for IGB (P<.05). The EWL % and EBMIL % at the end of the 12th month were 57% and 70%, which is significant in favor of IGB. The last evaluation was made at the 18th month of applications, and the three parameters for two applications were found to be similar. The achieved weight losses at the 6th month were similar for both groups. However, at the 12th month, two consecutive IGB applications were more effective. At the end of the 18th month, the results were again similar. Two consecutive IGB applications may be offered to obese patients who do not feel ready for surgery.