Intragastric Balloon Placement Research Articles

Factors contributing to weight loss success after bariatric procedures in patient over 65 years old - a multicenter retrospective cohort study.

Although bariatric surgery in patients over 65 years of age gives comparable results to treatment in the younger population, there are still controversies regarding the indications for surgery, risk assessment and choice between different types of surgery. The study aimed to identify the factors contributing to weight loss success after bariatric surgery in patients over 65 years of age. This is a retrospective, multicenter cohort study of patients with obesity aged over 65 years undergoing primary laparoscopic bariatric surgery in the years 2008-2022. Data came from 11 bariatric centers. Patients were divided into two groups: responders (R) who achieved more than 50% EWL and non-responders (NR) who achieved less than 50% EWL. Both groups were compared. Uni- and multivariate logistic regression was used to identify predictors of weight loss success. Out of 274 analyzed patients, the average BMI before surgery was 42.9kg/m2. The most common obesity-related diseases were hypertension (85.1%) and type 2 diabetes (53.3%). Sleeve gastrectomy was the most frequently performed procedure (85.4%). Uni- and multivariate logistic regression analysis confirmed preoperative BMI (OR=0.9, 95%CI:0.82-0.98, P=0.02), duration of diabetes >10 years (OR=0.3, 95%CI:0.09-0.82, P=0.02), balloon placement (OR=10.6, 95%CI: 1.33-84.83, P=0.03), time since first visit (OR=0.9, 95%CI:0.84-0.99, P=0.04), preoperative weight loss (OR=0.9, 95%CI:0.86-0.98, P=0.01) and OAGB (OR=15.7, 95%CI:1.71-143.99, P=0.02) to have a significant impact on weight loss success 1 year after bariatric surgery. Patients with higher preoperative weight loss may have a poorer response to surgery. OAGB emerged as the most beneficial type of surgery in terms of weight loss. Intragastric balloon placement before surgery may be effective in patients above 65 years of age and may be considered as a two-stage approach.

Changes in Food Preferences Before and After Intragastric Balloon Placement.

In recent years, numerous studies have tried to decode the way bariatric surgery works toward weight reduction by the use of food preference questionnaires. The intragastric balloon has gained popularity, mainly due to its limited invasiveness, in patients with obesity not fulfilling criteria for bariatric surgery. However, there is no study assessing the changes in food preferences [FP]. We decided to analyze the FP of individuals prior to intragastric balloon insertion and following its removal, on the strict condition that participants must complete the 6-month treatment period and attend at least 4 of the 7 follow-up interviews. Patients were asked to rate the frequency of consumption of 63 food items before balloon insertion, at monthly intervals and after balloon removal. The food categories were protein, carbohydrates, fruit and vegetables, and sweets and fats. The questionnaires of 320 participants were analyzed. A reduced frequency in consumption of meat and meat products, high-fat, and high-carbohydrate/sugary products and an increase in raw vegetables and fruit was found in all individuals. The intragastric balloon seems to exert analogically similar mechanisms to bariatric surgery for weight loss, both functioning through alterations in FP. These are dictated by the anatomical re-configuration of the stomach, but mainly by counseling of dieticians and the self-education of the patient after experiencing unpleasant postprandial discomfort.

The current status and challenges of perioperative management of patients with a BMI of greater than or equal to 50kg/m 2 undergoing bariatric surgery in China: a multicenter cross-sectional study.

Performing bariatric surgery on patients with a BMI of over 50kg/m 2 is challenging. This study aimed to explore the status and challenges related to the perioperative management of such patients in China. A prospective survey was designed to investigate the perioperative management of patients with a BMI of greater than or equal to 50kg/m 2 undergoing bariatric surgery in China. The questionnaire of our survey included general information, preoperative management measures, surgical procedures performed, technical details regarding anaesthesia, and postoperative management measures. A response from only one attending physician per bariatric centre was accepted. Physicians from a total of 101 hospitals responded to the questionnaire, and the questionnaire data from 98 hospitals were complete. These centres had completed a total of 44702 bariatric surgeries since the launch of such surgery to December 2021. A total of 3280 patients had a BMI exceeding 50kg/m 2 . The preferred surgical procedures for patients with super obesity were sleeve gastrectomy by 62 centres, Roux-en-Y gastric bypass by 11 centres, sleeve gastrectomy plus jejunojejunal bypass by 19 centres, one anastomosis gastric bypass by 1 centre, and duodenal switch by 1 centre. The most worrying issues were cardiopulmonary failure and difficulty in extubation. 91 centres believed that preoperative weight loss was beneficial. A low-calorie diet was the specific measure mainly implemented, only three centres considered using intragastric balloon placement. Postoperative management measures varied greatly. Bariatric surgery has seen rapid development. Chinese physicians show significant differences regarding the perioperative management for patients with a BMI of over 50kg/m 2 . The perioperative risks of these patients remain relatively high, making further development of clinical pathways is necessary.

Celiac artery mesenteric fat measurement with endosonography (CAMEUS) reliably correlates with obesity and related comorbidities.

Visceral fat represents a metabolically active entity linked to adverse metabolic sequelae of obesity. We aimed to determine if celiac artery mesenteric fat thickness can be reliably measured during endoscopic ultrasound (EUS), and if these measurements correlate with metabolic disease burden. This was a retrospective analysis of patients who underwent celiac artery mesenteric fat measurement with endosonography (CAMEUS) measurement at a tertiary referral center, and a validation prospective trial of patients with obesity and nonalcoholic steatohepatitis who received paired EUS exams with CAMEUS measurement before and after six months of treatment with an intragastric balloon. CAMEUS was measured in 154 patients [56.5% females, mean age 56.5 ± 18.0 years, body mass index (BMI) 29.8 ± 8.0 kg/m2] and was estimated at 14.7 ± 6.5 mm. CAMEUS better correlated with the presence of non-alcoholic fatty liver disease (NAFLD) (R2 = 0.248, P < 0.001) than BMI (R2 = 0.153, P < 0.001), and significantly correlated with metabolic parameters and diseases. After six months of intragastric balloon placement, the prospective cohort experienced 11.7% total body weight loss, 1.3 points improvement in hemoglobin A1c (P = 0.001), and a 29.4% average decrease in CAMEUS (-6.4 ± 5.2 mm, P < 0.001). CAMEUS correlated with improvements in weight (R2 = 0.368), aspartate aminotransferase to platelet ratio index (R2 = 0.138), and NAFLD activity score (R2 = 0.156) (all P < 0.05). CAMEUS is a novel measure that is significantly correlated with critical metabolic indices and can be easily captured during routine EUS to risk-stratify susceptible patients. This station could allow for EUS access to sampling and therapeutics of this metabolic region.

IBC-Oxford University2023_BJSPoster_12Outcomes of Intra-Gastric Balloon as a first step before bariatric surgery for the treatment of patients with super obesity (BMI&amp;gt;50)

Abstract Introduction The treatment of super obesity, defined as a body mass index (BMI) ≥ 50 Kg/m2, presents several challenges. The best therapeutic strategy is debatable and dependent on each case. The intragastric balloon (IGB) can be used as a "neoadjuvant" therapy before metabolic/bariatric surgery (MBS). The purpose of this study is to evaluate the outcomes and safety profile of the IGB as a first step before MBS for the treatment of super obese patients. Methods Retrospective study of all patients with BMI ≥ 50 Kg/m2 submitted to intragastric balloon placement before MBS between 2009 and 2023. Several variables were analysed including weight loss outcomes, adverse events, and complications of IGB. Therapeutic failure of IGB was defined as %TWL&amp;lt; 5 or early removal of IGB due to adverse events. Results We identified 74 patients with BMI≥ 50 Kg/m2 that were proposed for intragastric balloon placement prior to bariatric surgery, of which 56 (76%) were women, with a mean age of 43,0 ± 11,8 years. The mean initial BMI was 59,4 ± 5.3 Kg/m2. The intragastric balloon remained in the patient for 7,0 ± 1,4 months. The weight loss up to the moment of subsequent bariatric surgery was 22,5 ± 13,2 Kg and the percentage of total weight loss (%TWL) was 14.4 ± 8.4%. The overall rate of complications was 23% (17), the most frequent being nausea and vomiting, of which 50% (8) led to an emergency service visit and 50% (8) to rehospitalization. Regarding serious complications, 3 were identified: 1 gastric perforation and 2 severe respiratory complications, one of which resulted in mortality. Out of the 74 patients, 9 (12%) did not achieve the pre-established %TWL &amp;lt; 5 and 4 (5%) had to remove the intragastric balloon beforehand. Conclusion This study demonstrates that the intragastric balloon is a possible "neoadjuvant" therapeutic strategy in this particularly difficult group of patients, resulting in satisfactory weight loss. However, it has a non-negligible complication rate that should be considered when planning each patient's therapeutic strategy.

Early safety and efficacy comparison of endoscopic bariatric interventions.

Intragastric balloon (IGB) placement and endoscopic sleeve gastroplasty (ESG) are the 2 primary endoscopic bariatric therapies currently performed in the United States. Procedural selection is often based primarily on patient preference. There is a paucity of comparative data between these interventions. The aim of this study is to compare the short-term safety and efficacy of IGB to ESG in the largest, direct comparative analysis to date. Accredited bariatric centers across the United States and Canada. We retrospectively analyzed patients who underwent IGB or ESG from 2016 to 2020 from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. IGB patients were propensity matched (1:1) to ESG patients. We compared readmissions, reinterventions, serious adverse events (SAE), weight loss, procedure time, and length of stay between the 2 interventions. All outcomes were measured within 30 days of the initial procedure. A total of 1998 pairs of patients who underwent IGB and ESG were propensity matched with no difference in baseline characteristics. Patients who underwent ESG had more readmissions within 30 days. Patients who underwent IGB had more outpatient treatments for dehydration and re-interventions, with 3.7% of patients undergoing early balloon removal less than 30 days from implantation. Both procedures had similarly low rates of SAE (P > .05). ESG led to greater total body weight loss at 30 days. ESG and IGB are both safe procedures with comparably low rates of SAE. Higher rates of dehydration and re-interventions after IGB suggest that ESG is perhaps better tolerated.

S4157 A Case Series: Early Gastric Outlet Obstruction Secondary to Intragastric Balloon Placement

S4157 A Case Series: Early Gastric Outlet Obstruction Secondary to Intragastric Balloon Placement

Endoscopic Intra gastric Balloon placement for Obesity: Case series of the first five balloons placed in Sri lanka

With the rising prevalence of obesity in Sri Lanka, effective treatment strategies are essential. Traditional approaches to reduce excessive weight are dietary changes, exercise, medications, and behavioral modification. Bariatric surgery is one of the most effective weight loss methods available to provide sustained outcomes but are considered invasive and therefore less accepted. Endoscopic placement of an intragastric balloon (IGB) is a minimally invasive technique used to induce short-term weight reduction. IGB is a successful technique used to manage obesity worldwide. Here we report the first five cases of IGB placement in Sri Lanka.

Comparison of the Efficacy and Safety of the FDA-approved Intragastric Balloon Systems in a Clinical Setting.

The gas-filled intragastric balloon (IGB) system (Obalon) and the fluid-filled IGB system (Orbera) are the current FDA-approved IGB systems to treat obesity; however, they have not been previously compared in clinical practice. The aims of this study were to compare their efficacy, tolerance, and safety in a clinical setting. This is a retrospective cohort study of consecutive patients treated with the gas-filled IGB or fluid-filled IGB between October 2015 and May 2020 at 2 academic centers. The primary endpoints included percent total body weight loss at balloon removal in patients who completed at least 20 weeks of therapy, the difference in adverse events that required urgent evaluation or hospitalization, and early removal in the 2 groups. A total of 87 patients underwent successful IGB placement (gas-filled IGB n=57, age 48.9±8.8, body mass index 35.5±5 kg/m2; fluid-filled IGB n=30, age 49.2±14.3, body mass index 38.8±6 kg/m2). Eleven patients underwent early device removal. There were no differences in percent total body weight loss at balloon removal and 12 months between the balloon systems (P=0.39). Patients who received the fluid-filled IGB were more likely to require urgent evaluation or treatment, require hospital stay >24 hours, and need early balloon system removal compared with patients treated with the gas-filled IGB. In this 2-center cohort, both FDA-approved gastric balloon systems had the same effectiveness, but the gas-filled IGB had fewer serious adverse events and better tolerability than the fluid-filled IGB.

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.

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

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.

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.

NAFLD: A pretransplant and post-transplant conundrum.

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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.

Gastric Emptying and Its Correlation With Weight Loss and Body Mass Index in Patients With an Intragastric Balloon: A Prospective Study With Six Years of Follow-Up.

Background Obesity is the most well-established and prolonged pandemic in modern society. Having a better understanding of the available tools is important to improve weight loss and make the strategies more productive. This study aims to evaluate the effect of intragastric balloon (IGB) on gastric emptying time, its relationship with weight loss after IGB removal, and weight maintenance after six years. Methodology This prospective study analyzed data from patients undergoing IGB placement. A six-years follow-up was performed and data about weight maintenance were collected. We analyzed the impact of the IGB on gastrointestinal motility and its correlation with weight loss. Results Of the 20 patients included in the study, 52.4% were diagnosed with class I obesity and 47.6% with class II obesity. The mean weight of the patients was 96.5 ± 11.9 kg at baseline, 79.6 ± 11.4 kg at the time of IGB removal, 81.8 ± 9.1 kg at six months, and 93.2 ± 14.3 kg six years after IGB removal. The mean difference between the initial weight and that measured immediately after IGB removal was 16.68 ± 5.71 kg. Regarding gastric emptying time, there was a difference in retention on comparing the measurement before balloon placement to that after the balloon was in place (72.9% vs. 86.8%) after one hour of food intake. Comparing two hours after food intake, patients before IGB placement had a 30.6% food retention, while patients with IGB in place had a 69.2% retention. Conclusions In patients with class I or II obesity, the use of an IGB delayed gastric emptying of foods but showed no direct correlation with weight loss. Weight loss achieved after IGB placement was maintained in half of the patients at a six-year follow-up.

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.

Comparing Intragastric Balloon Placement with Low Calorie Diet in Short-Term Weight Loss

Comparing Intragastric Balloon Placement with Low Calorie Diet in Short-Term Weight Loss

S3588 Eosinophilic Gastroenteritis and Colitis After Intragastric Balloon Placement

Introduction: Eosinophilic gastrointestinal diseases (EGIDs) are a group of rare disorders characterized by infiltration of eosinophils in the gastrointestinal tract. Hypersensitivity to food or environmental allergens is believed to play a pivotal role in the pathogenesis. Intragastric balloon (IGB) has been demonstrated as an effective and safe therapy for weight loss. Interestingly, a previous report described development of eosinophilic esophagitis (EoE) following IGB placement, suggesting a possible association between IGB and EGIDs. Case Description/Methods: A 61-year-old male underwent endoscopic placement of an Orbera® intragastric balloon for weight reduction. Forty days later, he presented with a 3-day history of watery and non-bloody diarrhea, abdominal pain, and nausea. Labs were notable for severe peripheral eosinophilia over 15,000/mL. Extensive infectious workup were unremarkable. His IGB was removed as he had reached his goal weight. Then, he underwent esophagogastroduodenoscopy and flexible sigmoidoscopy with biopsy. Endoscopic exam was notable for diffuse erythema in the stomach and duodenum, and congestion in the colon. Histologically, dense inflammatory infiltration of eosinophils and plasma cells in the lamina propria was found in the stomach, duodenum, and colon. After removal of the IGB, his symptoms and peripheral eosinophilia improved rapidly, and were resolved completely within 1 month without need for immunomodulatory therapies or diet modifications. Discussion: We describe a case of eosinophilic gastroenteritis and colitis with severe peripheral eosinophilia following IGB placement, in whom rapid resolution occurred after IGB removal without additional therapies. To our knowledge, this is the first case report that suggests a possible association between IGB and non-EoE EGIDs, which warrants clinicians' awareness and further studies.

S1067 Endoscopic Sleeve Gastroplasty vs Intragastric Balloon: A Large, Database Analysis of Early Safety and Efficacy

Introduction: Intragastric balloon (IGB) placement and endoscopic sleeve gastroplasty (ESG) are the two most common endoscopic bariatric therapies currently performed in the United States. Procedural selection is often based primarily on patient preference. There is a lack of comparative data to help guide patient discussions regarding these interventions. This study is the largest study to date to directly compare short-term safety and efficacy of IGB to ESG using a large international bariatric database. Methods: All patients undergoing ESG and IGB across 800 hospitals in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database from 2016-2020 were included. All patients undergoing IGB were propensity matched to patients undergoing ESG. We compared occurrences of serious adverse events (SAE), readmissions, re-interventions, and emergency room (ER) visits within 30-days after procedure. Secondary outcomes included procedure time, length of stay (LOS), and total body weight loss (TBWL) measured at 30 days. (Table) Results: A total of 1,996 patients underwent IGB and 6,054 patients underwent ESG. All IGB patients were propensity matched to 1,996 ESG patients, with no differences in baseline characteristics. ESG and IGB had similarly low rates of SAE (p > 0.05). ESG had more readmissions within 30 days (p< 0.05). IGB had more outpatient treatments for dehydration and re-interventions within 30 days (p< 0.05), with 3.7% of patients reporting early balloon removal less than 30 days after implantation. ESG had greater %TBWL at 30 days (p< 0.05). Conclusion: ESG and IGB are both safe procedures with comparably low rates of SAE. ESG is perhaps better tolerated than IGB. Table 1. - ‡ Most common reason for readmission after both procedures was nausea, vomiting, and fluid/electrolyte or nutritional depletion. § Most common type of intervention after IGB was early IGB removal. The most common intervention after ESG was therapeutic endoscopy with stent placement or dilatation Comparing Short Term (30d) Procedural Outcomes of Endoscopic Sleeve Gastroplasty and Intragastric Balloon Placement ESG (n=1998) IGB (n=1998) p Mean BMI (SD) 36.36 (6.19) 36.17 (6.16) 0.316 Mean Change from Pre-Op to Post-Op BMI (SD) -1.51 (2.41) -0.95 (2.83) < 0.001 Mean % Total Body Weight Loss (%TBWL) (SD) 3.8% (7.9%) 2.3% (6.6%) < 0.001 Mean Number of Days from Procedure to Discharge (SD) 0.65 (1.76) 0.04 (0.33) < 0.001 Mean Procedure Length, minutes (SD) 64.97 (45.39) 16.51 (17.12) < 0.001 Serious Adverse Event, n (%) 17 (0.9) 5 (0.3) 0.055 Reoperation, n (%) 22 (1.1) 12 (0.6) 0.121 Readmission, n (%) ‡ 56 (2.8) 29 (1.5) 0.004 Re-Intervention, n (%) § 35 (1.8) 90 (4.5) < 0.001 Received Treatment for Dehydration Outpatient, n (%) 46 (2.3) 89 (4.5) < 0.001 Emergency Department Visit Not Resulting in Admission, n (%) 66 (3.3) 69 (3.5) 0.861