Bio-enteric intragastric balloon in obese patients: a retrospective analysis of King Faisal Specialist Hospital experience

Surgical Management of Intra-gastric Balloon Complications, Single-Center Experience, and Literature Review

INTRODUCTION

In Saudi Arabia, the prevalence of obesity has multiplied in the last decades leading to a surge in bariatric surgery and other endoscopic modalities. The intra-gastric balloon (IGB) is the most used endoscopic modality. Surgical management for IGB complications is required for gastrointestinal perforation and/or obstruction. However, the literature seems to underestimate these complications.

MATERIALS AND METHODS

A retrospective descriptive study was conducted in King Fahd University Hospital, Saudi Arabia, from Jan 2017 to Dec 2021, including all patients with complicated IGB who necessitated any surgical procedure. Exclusion criteria were patients with complicated IGBs that were only managed conservatively or endoscopically.

RESULTS

A total of 326 patients were admitted with different complications after bariatric procedures. Of them, six patients were referred due to IGB complications that necessitated operative intervention. All patients were young females. Three patients had gastric wall perforation, and were managed by endoscopic removal of the IGBs followed by exploratory laparotomy. One patient had an intestinal obstruction on top of a migrated IGB that was surgically removed. One patient had failed endoscopic retrieval of IGB and required a laparoscopic gastrostomy. Another patient had an esophageal rupture that required left thoracotomy, pleural flap, and insertion of an esophageal stent. All cases were discharged and followed up with no related complications.

CONCLUSION

IGB is an endoscopic alternative, within specific indications, for the management of obesity. However, surgical management may be necessary to manage its complications, including gastrointestinal perforation, IGB migration, and failure of endoscopic removal.

Intragastric Balloon Significantly Improves Metabolic Parameters at 6 Months: a Meta-Analysis

INTRODUCTION

It is estimated that by 2030, 38% of the world population will be overweight, and another 20% will be people with obesity. Intragastric balloons (IGBs) are an option in conjunction with lifestyle modification for the treatment of obesity. We sought to investigate the effects of IGB therapy on hemoglobin A1c (A1c), systolic and diastolic blood pressure (SBP, DBP), total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides (TGs).

METHODS

PubMed, Embase, and Google Scholar were queried through November 2021 to identify studies that evaluated the effects of IGB therapy on selected variables at 6 months. A total of 17 studies and 1198 patients met inclusion criteria. Results were pooled using a random-effects model.

RESULTS

At 6-month post-IGB insertion, patients had a significant reduction in A1c (mean difference (MD): - 0.62, 95% confidence interval (CI): - 0.884 to - 0.355, p < 0.001), SBP (MD: - 8.39, 95% CI: - 11.39 to - 5.386, p < 0.001), DBP (MD: - 5.807, 95% CI: - 8.852 to - 2.76, p < 0.001), TC (MD: - 9.189, 95% CI: - 15.763 to - 2.616, p = 0.006), LDL (MD: - 5.20, 95% CI: - 9.05 to - 1.35, p = 0.008), and TGs (MD: - 25.35, 95% CI: - 40.30 to - 10.10, p = 0.001). There was no significant difference in HDL (MD: 1.245, 95% CI: - 0.11 to 2.60, p = 0.071).

CONCLUSIONS

Our meta-analysis suggests that IGB therapy is associated with improvements in insulin resistance, blood pressure, and dyslipidemia at 6 months. The results of this analysis suggest that IGB placement can be a viable treatment option to improve important metabolic parameters beyond weight loss alone.

Intragastric Balloon Versus Endoscopic Sleeve Gastroplasty for the Treatment of Obesity: a Systematic Review and Meta-analysis

BACKGROUND

We aimed to individually evaluate IGB and ESG procedures and compare the efficacy, durability, and safety of these procedures.

METHODS

Bibliographic databases were systematically searched for studies investigating the use of IGB and ESG for the treatment of obesity. Studies reporting percent total weight loss (%TWL) or percent excess weight loss (%EWL) with at least 12 months of follow-up were included.

RESULTS

A total of 28 studies were included in the final analysis. Only 1 study directly compared ESG to IGB, 9 studies evaluated ESG alone, while 18 studies evaluated IGB. At 12-month follow-up after ESG, mean %TWL was 17.51 (95% CI 16.44-18.58), and %EWL was 60.51 (95% CI 54.39-66.64). Mean %TWL and %EWL after IGB at 12 months was 10.35 (95% CI 8.38-12.32) and 29.65 (95% CI 25.40-33.91), respectively. Mean %TWL and %EWL after IGB were significantly decreased at 18 or 24 months compared to 6 months indicating weight regain after IGB removal. ESG achieved significantly superior weight loss compared to IGB, the difference in mean %TWL was 7.33 (95% CI 5.22-9.44, p value = 0.0001) at 12 months. Serious adverse events were observed in < 5% for both procedures.

CONCLUSION

Although ESG and IGB are safe and effective for weight loss, our study suggests that ESG results in more significant and sustained weight loss. Nevertheless, a variety of approaches are essential to care for this underserved population, and there are several factors other than weight loss that should be considered in selecting the ideal therapy for individual patients.

Randomized Prospective Clinical Study of Spatz3® Adjustable Intragastric Balloon Treatment with a Control Group: a Large-Scale Brazilian Experiment

BACKGROUND

To analyze the results regarding weight loss and complications related to the Spatz3® adjustable intragastric balloon (IGB) in Brazil.

METHODS

This randomized prospective study covered patients who had undergone treatment using a Spatz3® adjustable IGB between October 2016 and June 2018 at a private clinic in Rio de Janeiro, Brazil. The patients had a minimum body mass index (BMI) of 27 kg/m². The study examined complications of Spatz3® treatment and BMI reduction, percentage of total weight loss (%TWL), and % of excess weight loss (%EWL).

RESULTS

One hundred eighty patients underwent a Spatz3® balloon implant in the period. The patients were randomly divided into one group in which the Spatz balloon was kept at the same volume (600 mL) throughout treatment (Control Group), and another adjustment group with 250 mL greater volume. The complication rate was 16.14%. No death or major complication occurred during the study. Mean BMI decreased from 39.51 to 32.84 kg/m² (p < 0.0001), bodyweight from 111.87 to 90.28 kg (p < 0.0001), and excess weight from 41.55 to 22.99 kg (p < 0.0001). The adjustment resulted in greater mean weight loss of 4.35 kg (- 8 to 17.6 kg), and the average time of the procedure was 7.12 ± 1.63 months. The upward adjustment group did not present greater %TWL, %EWL, or BMI reduction when compared with the control group (p = 0.4413, p = 0,9245, p = 0.2729, respectively).

CONCLUSION

This study shows that Spatz3® IGB treatment is an effective procedure for weight reduction, with no mortality but higher morbidity compared with traditional IGBs. This procedure also enabled the balloon to stay in place for longer. The efficacy of upward adjustment still requires further confirmation.

Response Rates with the Spatz3 Adjustable Balloon

BACKGROUND

Intragastric balloons (IGBs) have demonstrated efficacy; however, the percent of "responders" (> 25% estimated weight loss (EWL) or > 10% total body weight loss (TBWL)-as suggested by FDA) have been less reported. The Spatz3 adjustable intragastric balloon (AIGB) extends implantation to 1 year, decreases balloon volume for intolerance, and increases volume for diminishing effect.

AIM

The aim of this study is to determine the efficacy/responder rate of the Spatz3 AIGB.

METHODS

Implantations of Spatz3 in 165 consecutive patients (pts) in 2 centers were retrospectively reviewed. Mean BMI is 35.7, mean weight (wt) 99.1 kg, and mean balloon volume 495 ml (400-600 ml). Balloon volume adjustments were offered for intolerance and for wt loss plateau.

RESULTS

In total, 165 pts were implanted yielding mean wt loss of 16.3 kg, 16.4% TBWL, and 67.4% EWL. Response (> 25% EWL; 10% TBWL) was achieved in 146/165 (88.5%) of patients. Response rates differed for 136 pts with BMI < 40 (91.2%) and 29 pts with BMI > 40 (69%). Down adjustments in 20 patients (mean - 150 ml) allowed 16/20 (80%) to continue IGB therapy. Up adjustments in 64 patients (mean 5.4 months; mean + 260 ml) yielded additional mean wt loss of 5.7 kg. One gastric perforation (0.6%) occurred in a patient who experienced abdominal pain for 2 weeks. Five patients with small ulcers did not require balloon extraction.

CONCLUSIONS

(1) Within the limitations of a retrospective review, the Spatz3 balloon appears to be an effective wt loss balloon with better response rates in BMI < 40. (2) Up adjustments yielded a mean 5.7 kg extra wt loss. (3) Down adjustments alleviated early intolerance in 80% of patients. (4) These two adjustment functions may be instrumental in yielding a responder rate of 88.5%.

Obesity treatment by Bioenterics intragastric balloon: Iranian results

We studied the effectiveness, tolerability and safety of Bioenteric Intragastric Balloon (BIB) for treatment of obesity in Iranian population. 52 patients (46 female (88.5%), mean age: 35.5 ±10, mean body weight: 107.6±25.4 kg) referred to two major training hospitals in Tehran, Iran, after evaluation by a multidisciplinary team, underwent endoscopic BIB placement under unconscious sedation. BIB was removed after 6 months and patients were discharged with drug therapy and 1000 kcal diet. Weight and Body Mass Index (BMI) were assessed at baseline, 6 months and 1 year after BIB insertion. The mean weight and BMI at baseline were 107.6±25.4 kg and 39.4±7.9 kg/m2; 6 months after balloon placement, they were 88.7±21.9 kg and 32.5±7.4 kg and 6 months after balloon removal, they were 93.4±21.9kg and 34.85±8.2 kg/m2 respectively. The weight decline was statistically significant throughout the study and follow up with p value <0.001. The most frequent side effects were nausea and vomiting which were resolved in the majority of cases by one week. No major complications, such as death, gastric obstruction, gastric or esophageal perforation, or balloon displacement occurred in our study. BIB is a safe, effective and well-tolerated treatment of obesity, but its effects are temporary, so it should be accompanied and followed by other methods to achieve sustained weight reduction.

Gastric Perforation as a complication of intragastric balloon

Obesity is considered the most common nutritional disorder in Western countries and is related to multiple morbidity and mortality. There are different options for obesity treatment, including diet, behavioral therapy, medications, and surgery. If patients do not meet the criteria for bariatric surgery, intragastric balloons may be used to achieve weight reduction. Currently, the intragastric balloon is one of the most common bariatric procedures in obese patients in Europe. Gastric perforation associated with intragastric balloon is a rare but dangerous complication. We report a case of a 42-year-old female patient who presented to the emergency department with acute abdomen. Chest x-ray in an erect posture indicated free gas under the diaphragm. She had undergone placement of an intragastric adjustable balloon device 13 months earlier and was overdue for removal of the balloon. In the emergency theater, a large perforated ulcer was found in the posterior wall of the stomach, which was repaired laparoscopically. Her postoperative course was uneventful. We also review the literature on intragastric balloon-induced gastric perforation. Our case is a very rare report of late gastric perforation after adjustable intragastric balloon placement. We recommend regular follow-up and removal in proper time after insertion of the gastric balloon.

Efficacy of intragastric balloon on weight reduction: Saudi perspective

AIM

To evaluate the safety and efficacy of intragastric balloon (IGB) in weight reduction in obese patients referred to a tertiary hospital in the Kingdom of Saudi Arabia.

METHODS

Three hundred and one consecutive obese individuals, who underwent IGB placement during January 2009 to May 2015, were analyzed. The subjects aged 18 to 60 years and had a minimum body mass index (BMI) of 27 kg/m2. The IGB was placed under conscious sedation and kept for 6 mo. Anthropometric measurements were recorded during and after 6 mo of IGB removal.

RESULTS

The body weight, excess body weight, and BMI were significantly reduced at the time of IGB removal and 6 mo later. Body weight loss > 10% was achieved in 224 subjects at removal of IGB. End of treatment success and long-term success were both significantly observed in women (70 vs 11) (71 vs 12.5) respectively. Excess BMI loss was significantly higher in subjects retaining the IGB for over 6 mo both at the removal [43.44 ± 19.46 (n = 221) vs 55.60 ± 28.69 (n = 80); t = 4.19, P = 0.0001] as well as at the end of 6 mo' follow-up [46.57 ± 24.89 (n = 221) vs 63.52 ± 31.08 (n = 80); t = 4.87, P = 0.0001]. Within 3 d of IGB placement, two subjects developed pancreatitis and one subject developed cardiac arrhythmia. Intestinal obstruction due to displacement of IGB occurred in two subjects. All these subjects recovered uneventfully after immediate removal of the IGB.

CONCLUSION

IGB was effective in our cohorts. The observed weight reduction was maintained for at least 6 mo post IGB removal. IGB placement was safe with a satisfactory tolerance rate.

Evaluation of the results of treatment of morbid obesity by the endoscopic intragastric balloon implantation method

INTRODUCTION

Overweight and obesity are ranked in the fifth place among the risk factors responsible for the greatest number of deaths in the world.

AIM

To assess the effects of treatment of patients with morbid obesity using endoscopic intragastric balloon (IGB) implantation.

MATERIAL AND METHODS

Two hundred and seventy-two patients with obesity were treated using endoscopic intragastric balloon implantation. Upon analysis of the inclusion and exclusion criteria, the study covered a group of 63 patients with morbid obesity. The patients were implanted with the LexBal balloon. Reduction of excess body mass, changes to BMI values and ailments and complications divided into mild and severe were assessed.

RESULTS

Before intragastric balloon treatment, the average body mass index (BMI) value was 58.3 ±10.5 kg/m2, whereas after 6 months of treatment it decreased to 49.5 ±8.7 kg/m2. The patients with postoperative BMI equal to or greater than 50.0 kg/m2 reported nausea (69.7%), vomiting (51.5%), flatulence (45.5%), upper abdominal pain (36.4%) and general discomfort (424%) more frequently. Dehydration (9.1%) was also more frequent in this group, whereas frequency of occurrence of such ailments and complications as heartburn (23.3%) and oesophageal candidiasis (10.0%) was higher in the patients with postoperative BMI below 50.0 kg/m2.

CONCLUSIONS

Endoscopic intragastric balloon implantation is an effective and safe method of excess body mass reduction in patients with morbid obesity before a planned bariatric surgical procedure. Pre-operative excess body mass and BMI value and post-operative excess weight loss in patients with morbid obesity have no impact on frequency of occurrence of ailments and complications in IGB treatment.

The Impact of Intragastric Balloons on Obesity-Related Co-Morbidities: A Systematic Review and Meta-Analysis

ObjectivesTherapies less invasive than surgery and more effective than lifestyle and pharmacotherapy are needed to contend with the obesity epidemic. Intragastric balloons (IGBs) are a minimally invasive endoscopic weight loss method recently approved for use in the US. The purpose of the study is to assess the effect of IGBs on metabolic outcomes associated with obesity.MethodsMEDLINE, Embase, and Cochrane Database were searched through July 2016. Dual extraction and quality assessment of studies using Cochrane risk of bias tool were performed independently by two authors. Primary outcomes included the change from baseline in metabolic parameters. Secondary outcomes included resolution and/or improvement in metabolic co-morbidities and association with baseline parameters.Results10 randomized controlled trials (RCT) and 30 observational studies including 5,668 subjects were analyzed. There was moderate-quality evidence for improvement in most metabolic parameters in subjects assigned to IGB therapy as compared to conventional non-surgical therapy in RCTs: mean difference (MD) in fasting glucose change: -12.7 mg/dl (95% confidence interval (CI) -21.5, -4); MD in triglycerides: -19 mg/dl (95% CI -42, 3.5); MD in waist circumference: -4.1 cm (95% CI -6.9, -1.4); MD in diastolic blood pressure: -2.9 mm Hg (95% CI -4.1, -1.8). The odds ratio for diabetes resolution after IGB therapy was 1.4 (95% CI 1.3, 1.6). The rate of serious adverse events was 1.3%.ConclusionsIGBs are more effective than diet in improving obesity-related metabolic risk factors with a low rate of adverse effects, however the strength of the evidence is limited given the small number of participants and lack of long-term follow-up.

Intragastric balloon as an adjunct to lifestyle intervention: a randomized controlled trial

BACKGROUND/OBJECTIVES

This trial evaluated the safety and effectiveness of the Orbera Intragastric Balloon as an adjunct to lifestyle intervention.

SUBJECTS/METHODS

In this multicenter, randomized, open-label clinical trial, 255 adults with a body mass index of 30-40 kg m^-2 were treated and outcomes were assessed up to 12 months. Participants were randomized to endoscopic placement of an intragastric balloon plus lifestyle or lifestyle intervention alone. Balloons were removed at 6 months and lifestyle intervention continued for both groups through 12 months. At 9 months, coprimary end points were two measures of weight loss.

RESULTS

At 6 months, weight loss was -3.3% of total body weight (-3.2 kg) in the lifestyle arm vs -10.2% (-9.9 kg) in the balloon plus lifestyle arm (P<0.001); at 9 months (3 months postballoon removal), weight loss was -3.4% (-3.2 kg) vs -9.1% (-8.8 kg, P⩽0.001); and at 12 months, -3.1% (-2.9 kg) vs -7.6% (-7.4 kg, P⩽0.001). For the primary end points, at 9 months, mean percent loss of weight in excess of ideal body weight (s.d.) at 9 months was 26.5% (20.7) (P=0.32) and 9.7% (15.1) in the balloon and control groups, respectively. Also, 45.6% (36.7, 54.8) of the subjects randomized to the balloon achieved at least 15% loss of weight in excess of ideal body weight greater than the control group (P<0.001). The majority of balloon subjects experienced adverse events; 86.9% nausea, 75.6% vomiting, 57.5% abdominal pain and 18.8% had their device removed before 6 months because of an adverse event or subject request. Five subjects (3.1%) in the balloon group had a gastric abnormality at the time of device removal, and no ulcers were found.

CONCLUSIONS AND RELEVANCE

Intragastric balloon achieved greater short-term weight loss at 3 and 6 months postballoon removal than lifestyle intervention alone. Adverse gastrointestinal events were common.

Current status of intragastric balloon for obesity treatment

Endoscopic bariatric therapy may be a useful alternative to pharmacological treatment for obesity, and it provides greater efficacy with lower risks than do conventional surgical procedures. Among the various endoscopic treatments for obesity, the intragastric balloon is associated with significant efficacy in body weight reduction and relief of comorbid disease symptoms. Anatomically, this treatment is based on gastric space-occupying effects that increase the feeling of satiety and may also affect gut neuroendocrine signaling. The simplicity of the intragastric balloon procedure may account for its widespread role in obesity treatment and its applicability to various degrees of obesity. However, advances in device properties and procedural techniques are still needed in order to improve its safety and cost-effectiveness. Furthermore, verification of the physiological outcomes of intragastric balloon treatment and the clinical predictive factors for treatment responses should be considered. In this article, we discuss the types, efficacy, safety, and future directions of intragastric balloon treatment.

ASGE Bariatric Endoscopy Task Force systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting endoscopic bariatric therapies

The increasing global burden of obesity and its associated comorbidities has created an urgent need for additional treatment options to fight this pandemic. Endoscopic bariatric therapies (EBTs) provide an effective and minimally invasive treatment approach to obesity that would increase treatment options beyond surgery, medications, and lifestyle measures. This systematic review and meta-analysis were performed by the American Society for Gastrointestinal Endoscopy (ASGE) Bariatric Endoscopy Task Force comprising experts in the subject area and the ASGE Technology Committee Chair to specifically assess whether acceptable performance thresholds outlined by an ASGE Preservation and Incorporation of Valuable endoscopic Innovations (PIVI) document for clinical adoption of available EBTs have been met. After conducting a comprehensive search of several English-language databases, we performed direct meta-analyses by using random-effects models to assess whether the Orbera intragastric balloon (IGB) (Apollo Endosurgery, Austin, Tex) and the EndoBarrier duodenal-jejunal bypass sleeve (DJBS) (GI Dynamics, Lexington, Mass) have met the PIVI thresholds. The meta-analyses results indicate that the Orbera IGB meets the PIVI thresholds for both primary and nonprimary bridge obesity therapy. Based on a meta-analysis of 17 studies including 1683 patients, the percentage of excess weight loss (%EWL) with the Orbera IGB at 12 months was 25.44% (95% confidence interval [CI], 21.47%-29.41%) (random model) with a mean difference in %EWL over controls of 26.9% (95% CI, 15.66%-38.24%; P ≤ .01) in 3 randomized, controlled trials. Furthermore, the pooled percentage of total body weight loss (% TBWL) after Orbera IGB implantation was 12.3% (95% CI, 7.9%–16.73%), 13.16% (95% CI, 12.37%–13.95%), and 11.27% (95% CI, 8.17%–14.36%) at 3, 6, and 12 months after implantation, respectively, thus exceeding the PIVI threshold of 5% TBWL for nonprimary (bridge) obesity therapy. With the data available, the DJBS liner does appear to meet the %EWL PIVI threshold at 12 months, resulting in 35% EWL (95% CI, 24%-46%) but does not meet the 15% EWL over control required by the PIVI. We await review of the pivotal trial data on the efficacy and safety of this device. Data are insufficient to evaluate PIVI thresholds for any other EBT at this time. Both evaluated EBTs had ≤5% incidence of serious adverse events as set by the PIVI document to indicate acceptable safety profiles. Our task force consequently recognizes the Orbera IGB for meeting the PIVI criteria for the management of obesity. As additional data from the other EBTs become available, we will update our recommendations accordingly.

Primary endoscopic therapies for obesity and metabolic diseases

PURPOSE OF REVIEW

Endoscopic approaches to obesity may help fulfill the unmet need of over half the US adult population who would benefit from therapy for obesity but are not receiving it. Endoluminal approaches have the potential to be more efficacious than antiobesity medications and have a lower risk-cost profile compared with bariatric surgery. This review outlines the current state of primary endoscopic weight loss and metabolic therapies and sheds light on the challenges faced toward making endoscopic bariatric therapies 'ready for prime time'.

RECENT FINDINGS

Endoscopic approaches to obesity are being increasingly modeled on the proposed mechanisms contributing to the benefits of bariatric surgery.Therapies targeted at the stomach induce weight loss with only a proportional benefit to underlying metabolic disorders.Therapies targeting the proximal small bowel appear to modulate various neurohormonal pathways resulting in an improvement in metabolic profile in excess to that accounted for by weight loss itself.

SUMMARY

Rigorous scientific assessment of endoscopic approaches to obesity is necessary to allow its integration into the treatment algorithm of obesity. The endoscopic armamentarium against obesity continues to evolve with the endoscopist poised to be a key player in the management of this disease.

VIDEO ABSTRACT

http://links.lww.com/COG/A12.

Efficacy of intragastric balloon for the management of obesity: experience from Kuwait

INTRODUCTION

Traditional methods of treating obesity have shown only limited efficacy. Intragastric balloon (BIB) is considered a new potential alternative method in the management of obesity. There is limited information in the literature about the outcome of BIB in the region of the Arabian Gulf. This study examined the efficacy and satisfaction of BIB in obese patients in Al-Amiri Hospital in Kuwait.

METHODS

A retrospective review of BIB in patients from October 2009 through December 2012 at Al-Amiri Hospital, Kuwait, included 179 patients. Weight loss, complications, satisfaction level, and weight gain after removal of the balloon were assessed. The weight loss was analyzed further according to different demographic groups.

RESULTS

A total of 179 patients were included in the study. Their data were collected, and the pre-insertion and post-removal body mass index (BMI) was calculated. Before insertion of the BIB, there was a mean weight of 99.7 kg (SD 26.7); after removal, they showed a mean weight of 88.9 kg (SD 25). There was a mean weight loss of 10.9 kg (SD 8). The patients experienced a median excess weight loss of 38.5%. There was no significant variation in the weight loss according to age, gender, and nationality. There was a satisfaction level of 44% among the patients. Weight gain after removal was experienced by 34.7% of patients.

CONCLUSION

BIB seems to be an effective method of significant weight reduction with little complications, making it a good alternative in the management of obesity in females with lower BMI.

One-year adjustable intragastric balloons: results in 73 consecutive patients in the U.K

BACKGROUND

Most intragastric balloons have 6-month approval. We report results with the Spatz Adjustable Balloon: approved for 12 months and adjustable.

METHODS

Seventy-three patients (mean: age 45.5; weight 114.5 kg; BMI 36.6 kg/m2) scheduled for 1-year implantation with Spatz balloon (mean volume 417 ml saline). Adjustments performed for early intolerance and weight loss plateau.

RESULTS

Three patients failed insertion. There were 21 early removals (4 intolerant refusing adjustment; 3 deflations; 14 satisfied patients) leaving 49 patients at 12 months. Results of 70 patients (49 patients at 12 months and 21 patients at <12 months) were a mean 21.6 kg weight loss; 19% weight loss; and 45.7% EWL (excess weight loss). Ten intolerant patients were adjusted and lost additional mean 13.2 kg. Fifty-one patients with weight loss plateau scheduled for adjustment: adjustments failed in 6 and non-response in 7. The adjusted 38 patients lost an additional mean 9.4 kg and at extraction had mean 40.9% EWL with 18.7% weight loss. Three catheter impactions required surgical extraction, and three deflated balloons didn't migrate beyond stomach.

CONCLUSIONS

The Spatz balloon is an effective procedure without mortality; however, it carries a risk of catheter impaction necessitating surgical extraction (4.1%). The failure rate--4.1%; intolerance without ability to adjust balloon--5.5%; major complications occurred in 3 (4.1%); minor (balloon deflations) in 3 (4.1%), and 2 asymptomatic gastric ulcers at extraction (2.7%). The longer implantation period and adjustment option combine to produce greater weight loss, albeit <10% weight loss beyond the pre-adjustment weight loss.

Efficacy of intragastric balloon in obese Egyptian patients and the value of extended liquid diet period in mounting the weight loss

Abstract Background: The surgical management of morbid obesity is faced by several challenges. Alternative therapeutic strategies could have an important role in the perioperative risk reduction. The BioEnterics(®) intragastric balloon (BIB) (Inamed Health, Santa Barbara, CA) has been described as being effective in weight reduction and is used as a bridge before bariatric surgery. This study examined the efficacy of BIB in obese Egyptian patients and the value of the extended low caloric liquid diet program in weight loss.

SUBJECTS AND METHODS

A retrospective review of a prospectively maintained bariatric database was conducted. Weight changes and complications data were analyzed. Indications for BIB placement were discussed.

RESULTS

Records of 55 patients (11 males and 44 females) were retrieved. The mean initial body mass index (BMI) was 45.3±11 kg/m(2). The mean of excess body weight percentage was 111.96±53.2%. Nausea was reported in 30 patients (54.5%). Epigastric discomfort was reported in 23 patients (41.8 %), and vomiting was reported in 27 patients (49.1%). Six patients (10.9%) had an early removal of the balloon, whereas 4 (7.2%) had delayed removal (more than 6 months). The mean excess weight loss percentage (EWL%) was 17.2%. There was significant reduction in patients' BMI from 45.3 to 38.3 kg/m(2) (P<.001). There was no significant correlation between the EWL% and the gender, age, or initial BMI. Two patients had second balloon insertions without complications. There was no significant difference in the EWL% between the 1-week liquid diet group and the extended (4-week) low caloric diet group.

CONCLUSIONS

The BIB is effective and safe in weight reduction in obese Egyptian patients. The impact of extended liquid dieting period is not significant.

Adjustable intragastric balloons: a 12-month pilot trial in endoscopic weight loss management

Intragastric balloons are associated with (1) early period intolerance, (2) diminished effect within 3–4 months, and (3) bowel obstruction risk mandating removal at 6 months. The introduction of an adjustable balloon could improve comfort and offer greater efficacy. A migration prevention function, safely enabling prolonged implantation, could improve efficacy and weight maintenance post-extraction. The first implantations of an adjustable balloon with an attached migration prevention anchor are reported. The primary endpoint was the absence of bowel perforation, obstruction, or hemorrhage. Eighteen patients with mean BMI of 37.3 were implanted with the Spatz Adjustable Balloon system (ABS) for 12 months. Balloon volumes were adjusted for intolerance or weight loss plateau. Mean weight loss at 24 weeks was 15.6 kg with 26.4% EWL (percent of excess weight loss) and 24.4 kg with 48.8% EWL at 52 weeks. Sixteen adjustments were successfully performed. Six downward adjustments alleviated intolerance, yielding additional mean weight loss of 4.6 kg. Ten upward adjustments for weight loss plateau yielded a mean additional weight loss of 7 kg. Seven balloons were removed prematurely. Complications necessitating early removal included valve malfunction (1), gastritis (1), Mallory–Weiss tear (1), NSAID (2× dose/2 weeks) perforating ulcer (1), and balloon deflation (1). Two incidents of catheter shear from the chain: one passed uneventfully and one caused an esophageal laceration without perforation during extraction. The Spatz ABS has been successfully implanted in 18 patients. (1) Upward adjustments yielded additional weight loss. (2) Downward adjustments alleviated intolerance, with continued weight loss. (3) Preliminary 1-year implantation results are encouraging.

Mechanical ileus induces surgical intervention due to gastric balloon: a case report and review of the literature

A temporary non-surgical approach for treatment of obesity is the gastric balloon that serves as an alternative procedure for many patients with frustrated diet attempts. Deflation and displacement of the balloon resulting in acute intestinal obstruction and subsequent surgical intervention is a rare complication. A BioEnterics Intragastric Balloon was endoscopically implanted in a 35-year-old female with a body mass index (BMI) of 28 kg/m(2). The procedure succeeded without complications, and weight loss was effective during the first 6 months. One year after balloon implantation, the patient presented with abdominal cramps and vomiting due to ileal obstruction. Since endoscopic efforts to remove the deflated and displaced balloon failed, emergency laparotomy and enterotomy were necessary. Vascularization of the dilated small bowel was compromised, but recovered after decompression. Patients' postoperative course was uneventful. The gastric balloon model can be associated with major complications and should be used critically. Removal of the balloon should be assured not later than 6 months when weight loss decreases.

Gastric perforation as a complication after BioEnterics intragastric balloon bariatric treatment in obese patients--synergy of endoscopy and videosurgery

The BioEnterics intragastric balloon (BIB) is one of the most common bariatric procedures in obese patients in Europe. Associated gastric perforation is a rare, yet very dangerous, complication. We report a case of such a complication after BioEnterics intragastric balloon insertion in a 60-year-old female patient and subsequent cooperation between an endoscopist and bariatric videosurgeon in her treatment.