Intragastric Balloon Therapy for the Management of Obesity - Why The Bad Wrap?

Dr. Mark DeLegge and Dr. Joshua Evans (Fellow in Gastroenterology at the Medical University of South Carolina) published an article in the January/February issue of the Journal of Parenteral and Enteral Nutrition titled “Intragastric Balloon Therapy for the Management of Obesity. Why The Bad Wrap?”

In this article, it was pointed out that there could be a decline in the life expectancy of the U.S. population in the next few decades based on the epidemic of obesity. Diet and exercise can work to treat obesity, although the weight loss effects are limited and for a short duration in time. Surgery provides a more durable solution, but can be associated with major complications. The original endoscopic device for obesity was the Garron-Edwards intragastric balloon. However, at the time of its release in the 1980s, the device proved to be no better than sham controls in trials and there were associated complications of balloon deflation and small bowel obstruction. Because of this history, recent endoscopic techniques for the treatment of obesity focused away from gastric balloons and now included devices that allow intragastric stapling or suturing to create a reduced intragastric volume or a luminal sleeve that interferes with nutrient absorption. These devices are currently yet to be approved by the FDA and these endoscopic techniques can be endoscopically challenging to perform.

The simple concept and endoscopic technique associated with an intragastric balloon has evolved in the past few decades. Internationally, intragastric balloons have been shown to consistently result in durable weight loss over a one-year period. Although the weight loss may not be as significant as that which occurs with surgery, the overall cost of these procedures and associated morbidity and mortality are much less than a surgical intervention. A durable 10% total-body weight loss at one year has been reported, certainly markedly better than those reported with diet and exercise. Intragastric balloons would be a true “minimally invasive” approach to obesity. The right move in the treatment of obesity may be a step back to an endoscopic treatment – the gastric balloon.