Intragastric balloons reduce metabolic risk factors in obese patients

Last Updated: 2017-02-03

By Anne Harding

NEW YORK (Reuters Health) - Intragastric balloons (IGBs) are more effective than diet at improving metabolic risk factors in obese individuals, according to a new systematic review and meta-analysis.

"Intragastric balloons should be considered as a treatment option for patients with metabolic syndrome," Dr. Violeta Popov, director of bariatric surgery at the VA NY Harbor Healthcare System, told Reuters Health by phone.

IGBs have been used for decades in Europe, Dr. Popov noted. The balloon is placed in the patient's stomach endoscopically, in an outpatient procedure that takes about half an hour, she explained.

Patients have the device in place for six to eight weeks, and it is removed endoscopically, also in an outpatient procedure. The U.S. Food and Drug Administration approved two IGB devices in 2015 for treating patients with BMIs of 30-40 kg/m2, and has since approved one more.

To investigate whether IGB placement improves metabolic risk factors, Dr. Popov and her colleagues reviewed 10 randomized controlled trials (RCTs) and 30 observational studies including a total of 5,668 patients.

The RCTs provided moderate-quality evidence that IGB improved most metabolic parameters compared with diet, the researchers report in the American Journal of Gastroenterology, online January 24.

Mean difference (MD) in fasting glucose change was -12.7 mg/dl, while triglycerides fell by 19 mg/dl more with IGB. Waist circumference was reduced by an additional 4.1 centimeters with the device, while diastolic blood pressure fell by 2.9 mm Hg more. The odds for resolution of diabetes were also significantly better with IGB treatment (odds ratio, 1.4).

Serious adverse events occurred in 1.3% of patients, the team found.

In her own experience, Dr. Popov noted, patients will lose about 20 pounds in the first couple of weeks with the balloon, after which their weight loss slows. Many patients with diabetes may see it resolve, she added, so it is important that they be carefully monitored and avoid using insulin and diabetes medications if they don't need them.

"These patients have to be monitored very carefully, they have to be under close supervision, but the results are very encouraging," Dr. Popov said.

Many patients are able to maintain their weight loss even after having the balloon removed, she added, but this requires care from a multidisciplinary team including nutritionists and psychologists. "The balloon basically serves as a behavioral modification tool," the researcher said.

The main side effects are nausea and vomiting within two weeks of placement, which can be treated with medication, she added.

The next steps in the research should be to follow IGB patients for a longer period of time, and to conduct a multicenter randomized controlled trial of the device, the researcher said.

One of the study's authors has received consultancy fees and research support from Apollo Endosurgery, which makes an IGB device.

SOURCE: http://bit.ly/2k8yotT

Am J Gastroenterol 2017.