Intragastric Balloon for Overweight Patients

Abstract

Background and objectives: Current treatments for overweight adults include reduced-calorie diet, exercise, behavior modification, and selective use of medications. Many achieve suboptimal results with these measures and progress to obesity. Whether the intragastric balloon (IGB), a reversible device approved for treatment of obesity, is a safe and effective option in overweight adults is less well studied. We conducted a study to prospectively analyze the safety and effectiveness of IGB in overweight adults, to compare the results to a simultaneously studied cohort of obese patients, and to share procedural tips for safe IGB placement and removal.

Methods: One hundred thirty-nine patients were evaluated in this prospective, nonrandomized study. Twenty-six overweight [body mass index (BMI), 26-30)] and 113 obese (BMI > 30) patients underwent outpatient, endoscopic IGB placement under intravenous sedation. The IGB was filled with a 550-900 mL (average, 640 mL) solution of saline, radiological contrast, and methylene blue, with an approximate final proportion of 65:2:1. The patients were followed up at 1-2 weeks and then monthly for 6 months. At 6 months, they underwent IGB removal via an esophageal overtube to optimize safety, and then they were observed for 6 more months.

Results: IGB time was 190 ± 36 d in the overweight patients and 192 ± 43 d in the obese patients. Symptoms of IGB intolerance included nausea and pain, which were transiently present in 50-95% of patients for several days, and necessitated early IGB removal in 6% of patients. There were no procedure-related complications and no IGB-related esophagitis, erosion, perforation, or obstruction. The percentage of excess weight loss (EWL%) was 96 ± 54% in the overweight group and 41 ± 26% in the obese group (P < 0.001).

Conclusion: In overweight adults failing standard treatments, IGB placement for 6 months had an acceptable safety profile and excellent weight loss.

Keywords: Endoscopic device; Intragastric balloon; Obesity; Overtube; Overweight.

Figure 1.

IGB placement. (A) A polypectomy snare is used to grasp the tip of balloon sheet, and the balloon is inserted together with the endoscope. (B) Retrograde view of the endoscope (J-maneuver) showing the balloon totally inserted into the stomach fundus, just before it is filled. (C) Two syringes are used to fill the balloon. The blue syringe contains a solution of saline, radiological nonionic contrast (iopamiron) 20 mL, and methylene blue 1% 20 mL; the other syringe contains only saline. (D) When the fluid in the IGB reaches 100–150 mL, the sheet ruptures. (E) The filling is carefully monitored to so that the balloon reaches the most suitable size. At 350 mL, the balloon assumes a perfectly round shape. (F) After the balloon is filled completely, the insertion catheter is removed without any special maneuver, and the valve is carefully checked for leakage.

Figure 2.

A silicone double overtube is used to protect the airways during the removal procedure. (A) The overtube is placed over the endoscope. (B) The endoscope is inserted into the stomach. (C) Once the tip is inside the stomach, excess liquid is extracted, and the double overtube is carefully inserted into the esophagus. (D) The endoscope and the softer inner part of the overtube are removed. (E) Now, the endoscope can be safely reinserted into the stomach to proceed with balloon removal. (F) A needle is inserted, to puncture the balloon and remove the liquid by suction.

Figure 3.

Balloon removal. (A) After puncture, the suction catheter is inserted and the balloon is deflated. (B) A polypectomy snare is used to grasp the empty balloon in one corner; in the unlikely event that the balloon has no corner, but is flat, the use of double-hook forceps is recommended. (C) Part of the balloon is gently brought inside the overtube (∼20%). (D) The assembly with the endoscope, balloon, and overtube are removed ensemble. (E, F) The balloon and the overtube are removed simultaneously, enhancing the protection of the airways and thus ensuring the procedure's safety.