Six Months of Balloon Treatment does Not Predict the Success of Gastric Banding

Abstract

Background: We studied whether weight loss by intragastric balloon would predict the outcome of subsequent gastric banding with regard to weight loss and BMI reduction.Methods: A prospective cohort of patients with a body mass index (BMI) >40 kg/m 2 received an intragastric balloon for 6 months followed by laparoscopic adjustable gastric banding (LAGB). Successful ballooninduced weight loss was defined as ≥10% weight loss after 6 months. Successful surgical weight loss was defined as an additional 15% weight loss in the following 12 months. Patients were divided in group A, losing ≥10% of their initial weight with 6 months' balloon treatment, and group B, losing <10% of their initial weight.Results: In 40 patients (32 female, 8 male; age 36.6 yr, range 26-54), the mean BMI decreased from 46.5 to 40.5 kg/m 2 (P<0.001) after 6 months of balloon treatment and to 35.2 kg/m 2 (P<0.001) 12 months after LAGB. Group A (25 patients) and group B (15 patients) had a significant difference in BMI decrease, 12.4 vs 9.0 kg/m 2 (P<0.05), after the total study duration of 18 months. However, there was no difference in BMI reduction (4.7 kg/m 2 vs 5.8 kg/m 2 ) in the 12 months after LAGB. 6 patients in group A lost ≥10% of their starting weight during 6 months balloon treatment as well as ≥15% 12 months following LAGB. 6 patients in group B lost <10% of their starting weight after 6 months of BIB, but also lost ≥15% 12 months following LAGB.Conclusion: Intragastric balloon did not predict the success of subsequent LAGB.

Usefulness of an intra-gastric balloon before bariatric surgery

“…These values are similar to those described in the literature (4,22,24,37), with a 36.9% EWL in patients with effective balloons, and 15% in patients with balloon failure (32).…”

“…In our series, the proportion of failed balloons which did not achieve a significant weight loss (TBWL > 10%) was 34.5%, which is a high rate and very similar to that reported in other studies (32), highlighting the importance of patient involvement and a close clinical follow-up of patients in multidisciplinary visits (25,26) in order to achieve the best results regarding weight loss. This will probably involve changes in clinical practice, establishing weekly or biweekly personalized visits, at least during the initial months after the IGB placement.…”

“…Balloon tolerability was very good in our series; we did not have to remove any balloon before the determined time and this is better than that published in the literature, which describes 4.2-11% of patients who required balloon removal due to lack of tolerability or complications (24,(27)(28)(29)32).…”

“…Likewise, other authors have not found any differences in the post-surgical morbidity of patients with effective IGBs vs the sub-group of non-effective balloons; moreover, they did not find that the balloon was useful to predict the efficacy of a subsequent restrictive bariatric surgery, such as gastric banding (32).…”

“…It has been considered that treatment with an intragastric balloon has failed when a weight loss equal or lower than 10% of the initial total body weight (TBW) has been achieved (32).Total morbidity was considered as the postsurgical morbidity and the morbidity due to IGB.…”