Efficacy of Intragastric Balloons for Weight Loss in Overweight and Obese Adults: a Systematic Review and Meta-analysis of Randomized Controlled Trials

Kotinda, Ana Paula Samy Tanaka; Moura, Diogo Turiani Hourneaux de; Ribeiro, Igor Braga; Singh, Shailendra; Neto, Alberto Machado da Ponte; Proença, Igor Mendonça; Flor, Marcelo Mochate; Souza, Karina Lopes de; Bernardo, Wanderley Marques; Moura, Eduardo Guimarães Hourneaux de

doi:10.1007/s11695-020-04558-5

Cited by 42 publications

(17 citation statements)

References 40 publications

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“…IGB placement and commercial weight loss programs such as OPT have gained significant popularity and attraction over the last years, especially for the treatment of individuals with a BMI between 30 and 40 kg/m 2 , with various publications demonstrating both to be effective and safe [ 13 , 32 ]. To date, however, there have been no studies comparing the outcomes of these two nonsurgical weight loss procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Despite these advantages, bariatric surgery is still extremely invasive and costly and is likely to cause a vast number of complications that can be fatal [ 4 , 5 ]. While its effectiveness in the long term has yet to be demonstrated, intragastric balloon (IGB) therapy, first reported by Nieben et al in 1982 [ 12 ], is a less invasive and − at least potentially − a more cost-effective option for the treatment of obesity than surgery [ 13 , 14 , 15 , 16 , 17 ]. The presence of an IGB delays gastric emptying, causing a premature sensation of satiety and decreased food consumption [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2022

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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, costly and can have serious side effects. Intragastric balloon 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 intragastric balloon (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 to 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 (%EBWL), total body weight lost (TBWL), and percentage total body weight lost (%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 ± 10.4kg/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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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“…Those who underwent SG dropped their BMI significantly more than LLCD; those with an IGB did not lose significant weight (although only two studies were included). Remission or improvement in T2DM was reported in 63% of people; however, there were only 62 people with T2DM, and the criteria for remission were not outlined [35] .…”

Section: Metabolic Surgerymentioning

confidence: 99%

Metabolism and Target Organ Damage

Fearon¹,

Pournaras²

2022

Metab Target Organ Damage

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People with diabetes mellitus (DM) undergo more elective surgery than those without DM; however, up to half of the patients are undiagnosed when referred for surgery. This is an opportunity to intervene and instigate a management plan. Preoperative strategies may vary based on coexisting medical diseases such as obesity and the availability of resources with the aim of achieving glycaemic control while also treating coexisting conditions. In the context of obesity, there is substantial overlap in some of the treatment strategies. Guidelines, such as those from the UK Centre for Perioperative Medicine, suggest target glycated haemoglobin levels, preoperative fasting blood glucose levels, and when to defer an elective operation or instigate treatment to proceed if deemed safe. Preoperatively glycaemic control is often achieved pharmacologically, and newer agents, including glucagon-like peptide one receptor agonists (GLP1-RA) and sodium-glucose co-transporter 2 (SGLT2) inhibitors, are emphasised in the preoperative management of diabetes mellitus, particularly if obesity is also present. A very low-energy diet is an underutilised but well-evidenced method of achieving both glycaemic control and weight loss with a particularly dominant effect on liver fat which is helpful for people who are due to undergo abdominal surgery. Bariatric-metabolic procedures are of growing interest as bridging interventions to surgery and are more commonly used for obesity, but they also have a well-recognized impact on the improvement and remission of DM. This review gives an overview of the necessity of preoperative identification of DM and strategies for management. Intra-operative glycaemic control is also discussed, and the role of stress hyperglycaemia perioperatively.

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“…EBT includes a wide array of options, such as space-occupying devices (e. g., intragastric balloon [IGB]) 1 and restrictive procedures (e. g., endoscopic sleeve gastroplasty [ESG] and primary obesity surgery, endoluminal procedure) 2 . These procedures are in various stages of development, testing, and adoption, with the IGB having the most long-term data and ESG gaining more recent traction with a randomized clinical trial underway (MERIT trial, NCT03406975).…”

Section: Introductionmentioning

confidence: 99%

Does endoscopic mean safer? A comparison of the short-term safety of endoscopic versus laparoscopic bariatric therapies

et al. 2022

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Background and study aims There is minimal research on real-world, large-volume data comparing endoscopic bariatric therapy (EBT) to laparoscopic bariatric therapy (LBT). This study aimed to compare 30-day postoperative morbidity and mortality outcomes of primary EBT vs LBT using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Patients and methods Patients aged 18 to 80 with body mass index (BMI) 35 to 40 kg/m2 undergoing primary procedures were included. Propensity score matching 1:50 was performed for EBT versus LBT based on age, sex, and BMI. Results We matched 211 EBTs with 9,059 LBTs. Operative length (63.9, 95 % confidence interval [CI]: 57.9, 69.8 versus 81.1, 95 % CI: 80.1, 82.1) and length of stay (0.49 days, 95 % CI: 0.29, 0.69 versus 1.43 days, 95 % CI: 1.41, 1.45) were significantly lower in the EBT group than the LBT group. There was no difference between EBT and LBT in the odds of readmission (odds ratio [OR] = 0.31, 95 % CI: 0.08, 1.25), reoperation (OR = 0.39, 95 % CI: 0.05, 2.84), or reintervention (OR = 0.98, 95 % CI: 0.24, 3.99). After controlling for chronic obstructive pulmonary disease, sleep apnea, history of myocardial infarction, hypertension requiring medications, and diabetes, EBT continued to be associated with lower odds of having any adverse event (AE) than LBT, with an OR of 0.34 (95 % CI: 0.16, 0.69). Subgroup analysis comparing EBT to laparoscopic sleeve gastrectomy (LSG) showed that EBT was associated with a lower risk having any AE than LSG, with an OR of 0.39 (95 % CI: 0.19, 0.79). Conclusions EBT is associated with a lower 30-day AE rate and shorter procedural length and length of stay than LBT, with similar rates of readmission, reintervention, and reoperation.

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Efficacy of Intragastric Balloons for Weight Loss in Overweight and Obese Adults: a Systematic Review and Meta-analysis of Randomized Controlled Trials

Cited by 42 publications

References 40 publications

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

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

Metabolism and Target Organ Damage

Does endoscopic mean safer? A comparison of the short-term safety of endoscopic versus laparoscopic bariatric therapies

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