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Is There a Role for Gastric Balloons in Severe Obesity?



The idea of endoscopically placing a fluid-filled balloon into the stomach to enhance satiety and reduce food intake is by no means new. Often propagated as an alternative to dieting, the clinical utility of the balloon remains to be defined.

In my view the key limitation around the use of this device remains around the fact that it cannot be left in place forever and therefore can never be a definitive treatment for obesity – removal of the balloon, as with any diet, results in weight regain (barring the handful of individuals, who can keep the weight off by continuing on a strict caloric restriction and exercise program).

But there may well be clinical uses for the implantable balloon in certain situations – one example would be preparing extremely obese high-risk patients for a more definitive treatment.

This concept certainly appears promising based on a recent paper by Stephan Göttig and colleagues from Frankfurt am Main, Germany, published in this month’s issue of Bariatric Surgery.

This study retrospectively examined the results in 109 super- and super-super-obese patients (64 m and 45 f), with mean age of 39.1 y and mean BMI of 68.8, who underwent gastric balloon therapy (GBT) for weight loss.

Mean duration of balloon therapy was 177 days with a mean weight loss of around 26 Kg or around 9 BMI points. The greatest weight loss was seen in patients with BMI > 80. Not surprisingly, comorbidities improved markedly in around 60% of patients.

There were no major complications, but minor complications at balloon placement and removal occurred in a few patients.

69 patients went on to receive bariatric surgery. 10 patients received a second balloon.

This study clearly demonstrates the safety and efficacy of GBT in extremely obese patients particularly as a first step before a definitive anti-obesity operation.

I can think of similar situations, where weight loss may need to be achieved in severely obese patients before elective diagnostic or therapeutic procedures – not dissimilar to the previously proposed use of protein-sparing low calorie formula diets.

Clearly an interesting concept that may deserve further prospective evaluation in severely obese high-risk patients too sick to undergo a primary more definitive intervention.

AMS
Edmonton, Alberta

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