Intragastric Balloon for Management of Severe Obesity: A Systematic Review

Ekua Yorke1, Noah J Switzer1, Artan Reso2, Xinzhe Shi1, Christopher de Gara1, Daniel Birch1, Richdeep S Gill2, Shahzeer Karmali1. 1University of Alberta, 2University of Calgary

Introduction: We aimed to systematically examine the literature to determine the efficacy and safety of intragastric balloon therapy for obesity. Minimally Invasive, non-surgical options for weight-loss are gaining popularity. Specifically, the intragastric balloon (IGB) is an endoscopic procedure where a gastric space-occupying balloon induces satiety and restricts oral intake. Recently approved by the FDA, the intragastric balloon can act as a potential bridge therapy prior to definitive bariatric surgery in higher risk bariatric patients. However, one of the historic complications associated with older models of IGBs were their unacceptably high complication rates and inconsequential weight-loss.

Methods and Procedures: A comprehensive search (limited to English and human) of MEDLINE, EMBASE, SCOPUS, the Cochrane Library, and Web of Science from 1946 to July 2015 was completed. Title searching was restricted to the following keywords/terms: bariatric surgery, gastric bypass, gastric band, sleeve gastrectomy and intragastric balloon. 570 studies were identified and reviewed based on title and abstract and 147 studies were reviewed by full paper.

Results: Thirty-seven primary studies (n=6130) were included in this review. Mean patient age was 38.6 + 4.1 years and mean pre-operative weight and body mass index(BMI) were 126.8 kg + 27.8 and 43.1 kg/m2 + 8.6 respectively. Post-balloon removal at 6 months, mean weight loss, change in BMI, and excess weight loss (EWL) were 14.6 kg, 4.9 kg/m2, and 33.9%, respectively. The most common complications were nausea/vomiting (30.5%), abdominal pain (15.6%), and gastroesophageal reflux (12.5%). Serious complications were rare: mortality (0.1%), gastric ulcer (0.8%), gastric perforation (0.1%) and balloon migration (0.8%). Early balloon removal occurred in 7.6% of patients, most commonly due to intolerance (47.6%), balloon deflation (8.9%), nausea/vomiting (7.9%), and abdominal pain (7.0%).

Conclusion: IGB therapy is associated with marked short-term weight loss with limited serious complications. If a patient is able to tolerate the balloon, then IGB may be an important bridging therapy for the severely obese patient awaiting bariatric surgical intervention. 

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