Intragastric Balloon Insertion Research Articles

Routine Intra-gastric Balloon Insertion in the Management of 'Super-Super-Obese' Patients: an Obituary?

To prospectively evaluate the feasibility of single-stage bariatric surgery in patients with super-super obesity and compare their outcomes with patients undergoing intra-gastric balloon insertion as a bridging device prior to definitive surgery. Data from 42 patients with BMI 60-75kg/m2 who underwent either intra-gastric balloon insertion followed by sleeve gastrectomy (two-stage group); or attempted bariatric surgery as a single-stage procedure were compared. All patients in the single-stage group underwent successful bariatric surgery. Length of hospital stay after definitive bariatric surgery (3.3 ± 1.9 vs 2.2 ± 0.6days, p = 0.005) and overall complication rates were significantly higher in the two-stage group. Routine use of an intra-gastric balloon in super-super obese patients is not required and may be associated with poorer peri-operative outcomes and delayed weight loss.

Short-term Outcomes of Intragastric Balloon Placement for Obesity Treatment

Endoscopic treatment for obesity, especially intragastric balloon insertion, is on the rise in Korea. From 2016 to 2019, we performed intragastric balloon placement for the treatment of obesity in 12 patients at a single tertiary center. One balloon was removed on the next day due to nausea and severe abdominal pain, and the remaining 11 patients were followed up for 6 months. Body weight reduction of 8.9±5.4 kg was achieved, and the body mass index was reduced by 3.3±2.0 kg/m<sup>2</sup>. Significant effects regarding total body weight loss and excess weight loss were noted. The effect of weight reduction was greatest within 1 month after the procedure. Low density lipoprotein cholesterol significantly decreased by 18.0±18.2 mg/dL, but there were no significant changes in blood pressure, fasting blood glucose, total cholesterol, triglyceride, and high density lipoprotein cholesterol. Common adverse events were nausea and epigastric pain, but no serious adverse events occurred. Further studies regarding the long-term effects of endoscopic treatment for obesity and the improvement of metabolic syndrome are needed.

A View on Patterns of Weight Loss after Intragastric Balloon Insertion in Iraqi Patients

A View on Patterns of Weight Loss after Intragastric Balloon Insertion in Iraqi Patients

Intragastric balloon insertion and pancreatitis: Case series

IntroductionObesity is a complex multifactorial disease that affects populations worldwide. In Kuwait, the prevalence of obesity is a major public health problem. Intra-Gastric Balloon (IGB) is commonly used as a non-operative strategy among bariatric patients. However, with the increasing use of IGB, life-threatening adverse outcomes are widely reported. Presentation of casesA case series five patients presenting with pancreatitis from IGB in Kuwait is reported to better investigate the emerging complications of IGB. Three types of IGB were inserted, these include the Orbera Intragastric Balloon System, Orbera365 Intragastric Balloon System, and the Spatz Adjustable Gastric. The clinical course of balloon pancreatitis is described. DiscussionThe case series examined existing case reports of IGB associated pancreatitis in the literature, in addition to the investigated clinical outcomes. Patients presented with mild pancreatitis, and removal of balloon resulted in significant improvement in symptoms. Pathogenesis of balloon pancreatitis could be secondary to the pancreas compression by the IGB. ConclusionDespite the rarity of balloon pancreatitis, it needs to be recognized as a complication of IGB insertion. Further research is needed to better understand the implications of the balloon size, shape, volume and location of balloon insertion in order to prevent this fatal complication.

A view on Patterns of weight loss after Intragastric Balloon insertion in Iraqi Patients.

Obesity is a major metabolic illness that results from increased body fat and leads to negative health consequences. Obesity increases the prevalence of various diseases, including diabetes mellitus, hypertension, coronary heart disease, sleep apnea, CVA, GERD disease, gall bladder disease, certain types of malignancy, and non-alcoholic fatty liver disease[1]. Moreover, it is also a major avoidable health detriment. Current therapeutic approaches to obesity are lifestyle changes, pharmacologic treatment, and bariatric surgery.
 Patients and methods
 Twenty-seven patients visited our obesity clinic in Al Dewania Teaching Hospital from September 2016 to September 2017 and selected for intra-gastric balloon insertion after discussion with the patients, all current bariatric operative options beside the discussion to choose different balloon types. Air filled balloon was chosen.
 Result
 female to male ratio 3.1:1, with mean age 34±6.1 and mean body mass index 40.48 ± 5.16 had excess body weight 38.93 ± 8.44 Kg, all patients had been received IGB heliosphere 720 ml as treatment of their obesity. Each patient has been followed up 6 months and weight loss patterns observed. Mean weight loss after six month 9.6 ± 4.8 Kg
 Conclusion
 In regards of patient selection to the procedure, Patients should be selected according to their commitment to the recommended diet and life style modification, thiswould largely affect the outcome.

Changes in resting metabolic rate and body composition due to intragastric balloon therapy.

Intragastric balloon (IGB) insertion leads to dietary restriction; however, its neurohormonal actions were also described. Resting metabolic rate (RMR) adjusted for body mass (RMR/mass) seems to increase after bariatric interventions, whereas it generally decreases after caloric restriction-based therapies. However, no studies have evaluated the changes in body composition and RMR over IGB treatment. To evaluate the relationships between changes in body composition, RMR, RMR/mass, and RMR adjusted for fat-free mass (FFM) (RMR/FFM) over IGB treatment lasting 6 months. Single-center observational study. Twenty-one morbidly obese patients treated with IGB (143 ± 20 kg, body mass index [BMI] = 49.5 ± 7.3, 98% ± 29% percent excess weight, 43.6 ± 12.6 yr) were enrolled. Changes in body composition, RMR, RMR/mass, and RMR/FFM were evaluated between 1 month before IGB insertion (time point 1 [TP1]) and 3 months thereafter (TP2). Fourteen patients were also assessed 1 month after IGB removal (TP3). There was a 9.5% reduction in weight, a 9.4% reduction in BMI, and 19.1% decrease in percent excess weight at TP2 (n = 21; P < .001); a further 6.5% reduction in weight and BMI and a 13.1% drop in percent excess weight (n = 14, P < .001) at TP3. They were accompanied by a 5.4% reduction in FFM between TP1 and TP2 (n = 21, P < .001). Compared with pretreatment values, at TP2 RMR was 12.5% lower (P < .001) but did not change thereafter. RMR/mass increased 12.4% between TP2 and TP3 (n = 14, P = .02) but on average did not change between TP1 and TP3. The results in the smaller cohort (n = 14) between TP1 and TP2 were consistent with results obtained for the entire cohort. Similar findings were obtained for RMR/FFM. The larger increases in RMR/mass between TP1 and TP3 were associated with more weight loss, larger drop in BMI, and more loss of excess weight (r < -.55, P < .03). This is the first study to evaluate the relationship between changes in body composition and RMR over IGB treatment. IGB therapy leads to both fat and fat-free mass reductions and RMR decreases. More weight reduction is associated with larger increases in RMR/mass.

Gastric Perforation After Intragastric Balloon Insertion: A Case Report

Gastric Perforation After Intragastric Balloon Insertion: A Case Report

The Effect of Age, Gender, and Baseline BMI on Weight Loss Outcomes in Obese Patients Undergoing Intragastric Balloon Therapy.

The effect of age, gender, and baseline BMI as predictors of weight loss outcome in patients undergoing bariatric surgery is controversial with conflicting results in the surgical literature. Few studies evaluated the effect of age, gender, and baseline BMI on weight loss in patients undergoing the intragastric balloon (IGB). This study aimed to evaluate age and gender and baseline BMI as predictors of weight loss in a group of obese patients who were treated with the IGB. We prospectively followed 229 patients who underwent the Orbera IGB in the period between June 2014 and December 2017, performed at one institution. Data were collected for age, gender, baseline weight, and baseline BMI. At 6months of IGB insertion, the following parameters were documented: % excess weight loss (%EWL), total body weight loss (TBWL), and % total body weight loss (%TBWL). Patients were categorized according to gender and age groups: age less than 40years and age equal to or more than 50years (45 patients who were 40-49years old were excluded). Baseline BMI was grouped into 2 groups: BMI < 35 and BMI > 40. Patients in the BMI range of 35-40 were excluded. Linear regression analysis was used to evaluate the effect of age, gender, and baseline BMI on weight loss. T test was used to compare the means of TBWL, %EWL, and %TBWL between the groups studied. One hundred eighty-four patients (80% female) were enrolled in the study; 135 (106 females and 29 males) younger than 40years, and 49 (42 females and 7 males) with age equal or more than 50years. There was a significant effect of age on weight loss in females at 6months, with more weight loss (as measured by % excess weight loss) in the younger age group compared with patients aged 50years or more (% excess weight loss was 47.34% and 38%, respectively, p value = 0.04). There was no difference in % excess weight loss in the younger or older male patients (% excess weight loss was 50.21% and 47.05%, respectively, p value = 0.836). Patients of both sexes with lower baseline BMI had a significantly more % excess weight loss compared with the group with the higher baseline BMI (%EWL females/males 53.7%/50.1% and 32.5%/32.2%, respectively, p value <0.01). Female patients younger than 40years lost greater amount of excess weight than older patients at 6months after IGB insertion. On the other hand, age did not alter the outcome in male patients. Lower baseline BMI was significantly correlated with greater excess weight loss in both sexes. Age and baseline BMI can be used as predictors of weight loss outcome in patients treated with IGB.

Life-threatening visceral complications after intragastric balloon insertion: Is the device, the patient or the doctor to blame?

Background and aim Intragastric balloon placement is established as a safe, relatively low-cost and well-tolerated minimally invasive procedure for weight loss, giving encouraging results under the strict prerequisite that the obese patient will enroll in a medically supervised weight loss program. This retrospective study reviews already published cases of severe visceral complications for the purpose of assigning responsibility to the device, the patient, or the doctor. Methods We reviewed PubMed and Scopus archived publications describing intragastric balloon (BIB/Orbera)-related severe visceral complications, i. e. perforations and obstructions. Results Twenty-two cases of gastric perforation, two cases of esophageal perforation and 10 cases of bowel obstruction were found. For the gastric perforation the endoscopist was responsible in nine cases, the patient in four, and the balloon itself in nine. For the two cases of esophageal perforation, the endoscopists were responsible, while for the 12 cases of bowel obstruction, the patient was responsible for seven and the device for the other five cases. Conclusion BIB/Orbera balloon insertion remains a safe procedure, with a minimum of complications related to hollow viscera. Mandatory education and accreditation of physicians dealing with bariatric endoscopy and strict supervision of the obese individuals, while living with the balloon, will eliminate such complications.

Quality of life of obese patients after treatment with the insertion of intra-gastric balloon versus Atkins diet in Sulaimani Governorate, Kurdistan Region, Iraq.

BackgroundHealth-related quality of life of obese patients, before and after weight loss by insertion of BioEnterics Intra-gastric Balloon is studied widely. But the quality of life not related to comorbidity of the obese patients like mood, satisfaction with relationships, achieved goals, self-concepts, and self-perceived ability to cope with one's daily life is not studied on a wide scale.AimTo evaluates the effect of the obesity on different aspects of life, and to evaluate the influence of weight loss after BIB insertion or Atkins diet on the quality of life regarding mood, satisfaction with relationships, achieved goals, self-concepts, and self-perceived ability to cope with one's daily life.Patients, materials, and methodsA prospective randomized study, from a total of 180 patients, 80 patients were selected to enroll in the work, over a period of 4 years from 2008 to 2012 in Hatwan private hospital and the private clinic, the closing date was 1st January 2013.Approval for the current work was obtained from the Ethics Committee of University, College of Medicine. The work has been reported in line with the STROCSS criteria. The study was designed as a descriptive longitudinal study conducted on 40 patients who underwent intra-gastric balloon insertion compared to a matched group (for age, BMI) of 40 patients on Atkin's diet.ResultsTwo comparable groups of obese patients were studied, each group consists of 40 female patients, mean age in group A was 27 years (20–39 years) with mean body weight 90 kg (80–100) and mean body mass index 36 (31–39.9) who were treated with insertion of BIB. While mean age in group B was 29 years (20–39 years) with mean body weight 91 kg (80–102) and mean body mass index 36.5 (31–39.9). Statistically important changes occurred in the quality of life of the patients after either method of treatments to different degrees (p-value 0.005917).ConclusionThe patients lost more weight after insertion of intra-gastric balloon up to 35 kg of body weight, while the patients on Atkins diet lost up to 20 kg body weight. This results in statistically significant improvement of most aspects of QOL. Especially in Feeling happier, more satisfaction with the new body image, Improvement of self-esteem, encouraged for more regular exercises, less nervous, embarrassed less by unimportant matters, have less negative thoughts, and the craving of foods decreased remarkably.

The role of silent helicobacter pylori infection in intragastric ulcers induced by balloon insertion used for management of obesity

BackgroundObesity represents one of the common medical disorders that carries a high risk of morbidity and mortality. Insertion of intragastric balloon is one of the recently introduced lines of treatment of obesity. It allows patients to sense abdominal fullness and reduce their food intake. However, gastric ulceration may be a serious adverse effect that may be associated with intragastric balloon insertion. AimTo assess the role of silent helicobacter pylori infection in intragastric balloon-induced ulcers and to explore the possible methods for amelioration of this effect. MethodsThirty patients were divided into 2 equal groups; one of them received triple therapy for helicobacter pylori eradication and the other group received placebo treatment. Then, they underwent intragastric balloon insertion. After removal of the balloon, gastroscopy was performed to evaluate the gastric mucosal lesions, if present. ResultsThere was significant decrease in the incidence of gastric erosions and ulcerations in the group that received triple therapy for helicobacter pylori eradication compared to the group that received placebo treatment. ConclusionEradication of silent helicobacter pylori infection may represent a promising hope to decrease the incidence and improve symptoms of gastric erosions and ulceration that may be associated with intragastric balloon insertion.

Intragastric balloon therapy leads to normalization of brain magnetic resonance spectroscopic markers of diabetes in morbidly obese patients.

Elevated brain myo-inositol (m-Ins) concentration (a putative marker of neuroinflammation) has been reported in patients suffering from type 2 diabetes mellitus (T2DM). Obesity alone and T2DM have been found to be associated with a lower concentration of N-acetyloaspartate and N-acetylaspartylglutamate (tNAA, a marker of neuronal integrity, reflecting neuronal loss or metabolic derangement). It is not clear if these changes reverse with weight loss. The intra-gastric balloon (IGB) is an endoscopic bariatric therapy that leads to massive weight loss and improvement of glycemic control. In this study we evaluated if tNAA/tCr and m-Ins/tCr metabolite ratios are affected by weight loss, where tCr is the signal of creatine containing compounds. Twenty-three morbidly obese patients, 12 of them with T2DM (OD) and 11 without T2DM (OB), as well as 11 healthy controls of normal weight (CON), underwent single voxel spectroscopy at 3T. Spectra were obtained within a region in the left parietal white matter one month before IGB insertion, three months after IGB insertion, and one month after IGB removal. Before IGB insertion, m-Ins/tCr was 15% higher in OD than in OB (p=0.005) and 12% higher in OD than in CON (p=0.03). m-Ins/tCr decreased significantly by 8% over the first three months after IGB insertion (p=0.01) and remained normal after IGB removal. tNAA/tCr was normal in all groups throughout the study, pointing to normal brain metabolism. Normalization of m-Ins/tCr is consistent with remission of neuroinflammation in patients with T2DM. An evaluation of long-term effects of IGB treatment is necessary.

Acute complications following endoscopic intragastric balloon insertion for treatment of morbid obesity in elderly patients. A single center experience.

Obesity is a serious disease, with an increasing incidence also among subjects over 60 years old; surgical management has proven to be the most effective in the production of significant and durable weight loss. Intragastric balloon (IGB) treatment promotes a reduction of five to nine Body Mass Index (BMI) units in 6 months with an impressive improvement of obesity-associated comorbidities. Two hundred and twenty-five patients, 106 men (47.1%) and 119 women (52.9%), were evaluated at our institution to be submitted to a IGB positioning. Of these, 12 patients (8 women and 4 men) were more than 60 years old. For all patients BMI, comorbidities, weight loss and complications were recorded. χ2 test was used to evaluate differences in complications rate between elderly and other patients. For the 12 elderly patients, we recorded a mean excess weight loss rate (EWL%) of 31.4. About complications, we recorded 2 severe esophagitis requiring IGB removal and 1 late gastric perforation. A higher complications rate was found in elderly population and the comparison with other patients revealed a significant difference (P<0.001). Our results underline that IGB treatment in elderly patients is safe and effective in terms of weight loss and improvement in comorbidities. IGB can cause complications which, sometimes, can be severe such as esophageal damage and gastric perforation. For the management of complications, we highly recommend a close follow-up in all patients and a deepened instrumental study in every suspect case.

Intragastric Balloons for Overweight Populations-1Year Post Removal.

Endoscopic balloons have been used for years to treat obese seeking weight loss. This study evaluated the safety and effectiveness of our lifestyle modification program. Retrospective analysis of prospectively collected data from patients who underwent End-ball® (Endalis) intragastric balloon insertion with a multidisciplinary follow-up program. Demographic data, weight loss complications, and satisfaction rates were assessed. In total, 114 overweight/obese individuals from July 2012 to December 2015 were included. Mean age 36.5years (72% females). Initial body mass index (BMI) was 33.5kg/m2. Twelve early removals (10.52%) due to intolerance (n = 7), dissatisfaction (n = 4), and esophagitis (n = 1); 102 patients completed the program. BMI reduction ranged 5.5-6.4 at balloon removal and 4.1 1-year post removal. Average excess BMI loss (EBMIL) was 46-48% at balloon removal and 39.1% after 1year; 75% of participants maintained > 60% of their weight loss 1year after removal. EBMIL was 17 and 48% when initial BMI > 35 and ≤ 35kg/m2, respectively. At removal, 80% of patients were satisfied with the process. The End-ball® program resulted in significant weight loss that continued for 1year after balloon removal, with minimal complications. When treating overweight/obese populations, the main principles of the balloon insertion process should be no complications, high safety, and significant effectiveness. The process was most beneficial in the overweight and class I obese populations since average BMI was 33 and the class II obese had less weight loss and can possibly prevent future bariatric surgery.

Ischemic Renal Injury Complicating Intragastric Balloon Insertion

A 25-year-old obese woman experienced ischemic renal injury as a complication of intragastric balloon (IGB) insertion for weight reduction. Although IGB is associated with a low risk of renal injury in the form of acute renal failure, this presentation has never been reported. The patient responded well to treatment, with complete clinical and radiologic resolution after balloon removal. She did not have an apparent cause of renal ischemia other than a significant compression of the renal vessels by the balloon as seen on imaging.

Acute Pancreatitis: A Complication of Intragastric Balloon.

This study was carried out because intragastric balloon (IGB) is a widely used method to combat obesity, and acute pancreatitis complicating IGB is rare and yet to be understood. This study was a retrospective analysis of all patients with a history of IGB insertion, who developed acute pancreatitis before balloon removal. A total of 4 cases were found, with a mean age of 27±2.9 years. The mean duration of IGB insertion was 2.25±1.25 months, with an average body mass index of 37.7±3.4 kg/m. Abdominal computed tomography visualized signs of pancreatitis with the balloon compressing the pancreatic body. Pancreatitis resolved after endoscopic balloon extraction, with an average aspiration of 607.5±64.5 mL of the fluid used to fill the balloon. Our study demonstrates that acute pancreatitis can complicate IGB and recommends the need to measure amylase and lipase in patients who have a history of IGB insertion and present with a picture suggestive of pancreatitis.

Iatrogenic Esophageal Rupture during Intragastric Balloon Insertion: A Case Report and Review of Literature

Iatrogenic Esophageal Rupture during Intragastric Balloon Insertion: A Case Report and Review of Literature

Gastric Perforation Caused by an Intragastric Balloon: Endoscopic Findings.

Intragastric balloon (IGB) insertion has been most frequently used in the West as an effective endoscopic treatment for morbid obesity, in practice. Recently, there is a growing number of cases requiring IGB deployment for obesity treatment in Korea. One of the reported complications of IGB use is gastric perforation. A 47-year-old woman was admitted to the hospital with mild symptoms, 7 weeks after having an IGB placed. Esophagogastroduodenoscopy was performed and gastric ulcer perforation was observed in the ulcer base, where food particles were impacted. Laparoscopic primary repair was done successfully. This was a case of gastric perforation, secondary to poor compliance with a proton-pump inhibitor (PPI). PPI and Helicobacter pylori eradication are important for ulcer prevention following IGB deployment.

Does combining liraglutide with intragastric balloon insertion improve sustained weight reduction?

Background/Aim:Intragastric balloon (IGB) is an effective and safe method of weight reduction. However, IGBs have been associated with a high rate of weight regain post removal. Accordingly, ways to improve sustained weight reduction including concomitant treatment with Glucagon-like peptide 1 (GLP-1) agonists have been proposed. This study aims to evaluate the effect of adding Liraglutide to IGB insertion on sustained weight reduction.Patients and Methods:A retrospective analysis of all cases treated with IGB with or without Liraglutide was performed. Outcomes were statistically compared.Results:A total of 108 patients were included; 64 were treated with IGB alone and 44 with IGB + Liraglutide. Six months after removing IGB, patients treated with IGB + Liraglutide had a higher mean weight loss post treatment completion (10.2 ± 6.7 vs. 18.5 ± 7.6, P = <0.0001) than those treated with IGB alone. After adjusting for covariates, patients treated with IGB alone demonstrated a higher mean body weight loss at the time of IGB removal (coefficient 7.71, 95% CI = 4.78–10.63), and a higher odds of treatment success 6 months post IGB removal (OR = 5.74, 95% CI = 1.79–188.42). Baseline body mass index appeared to be a significant predictor of mean body weight loss at the time of balloon removal.Conclusions:Adding Liraglutide to IGB does not appear to decrease the risk of weight regain 6 months post IGB removal.

Does Intragastric Balloon Treatment for Obesity in Chronic Kidney Disease Heighten Acute Kidney Injury Risk?

Background: The outcomes of intragastric balloon (IGB) placement to achieve weight loss in obese patients with chronic kidney disease (CKD) have not been reported to date. This study aimed to assess the safety and efficacy of the IGB as a weight-loss treatment among this patient population. Methods: A prospective, single-arm, ‘first in CKD' interventional study was conducted in patients with a body mass index >35 kg/m² and CKD stages 3-4, referred for weight loss. After clinical assessment, the IGB was endoscopically inserted into the stomach and kept in place for 6 months. Complications, adverse events, acceptability, weight loss and metabolic responses were monitored over 6 months. Results: Eleven participants were recruited over 18 months. Two patients withdrew (1 prior to IGB insertion and 1 early removal after 3 days due to persistent vomiting) from the study; 9 patients completed the study. There were 5 episodes of acute kidney injury (AKI), occurring in 3 patients. After 6 months, the mean body mass decreased by 9.6% (SD ±6.8). Median waist circumference and total cholesterol decreased significantly (-7.7 cm; interquartile range (IQR) -15.3 to -3.9; and -0.2 mmol/l; IQR -0.6 to -0.05, respectively), with no changes in estimated glomerular filtration rate, blood pressure, triglycerides, adipokines, inflammation, or arterial stiffness measured by carotid-femoral pulse wave velocity. At IGB removal, there was 1 new case each of gastritis and esophagitis. Conclusions: Treatment with IGB has only moderate efficacy on weight loss; yet it results in a high rate of complications in obese patients with established CKD. The risk of AKI may be raised due to increased risk of dehydration secondary to gastrointestinal symptoms associated with IGB placement and reduced baseline kidney function.