The Impact of Intragastric Balloons on Obesity-Related Co-Morbidities: A Systematic Review and Meta-Analysis

Abstract

ObjectivesTherapies less invasive than surgery and more effective than lifestyle and pharmacotherapy are needed to contend with the obesity epidemic. Intragastric balloons (IGBs) are a minimally invasive endoscopic weight loss method recently approved for use in the US. The purpose of the study is to assess the effect of IGBs on metabolic outcomes associated with obesity.MethodsMEDLINE, Embase, and Cochrane Database were searched through July 2016. Dual extraction and quality assessment of studies using Cochrane risk of bias tool were performed independently by two authors. Primary outcomes included the change from baseline in metabolic parameters. Secondary outcomes included resolution and/or improvement in metabolic co-morbidities and association with baseline parameters.Results10 randomized controlled trials (RCT) and 30 observational studies including 5,668 subjects were analyzed. There was moderate-quality evidence for improvement in most metabolic parameters in subjects assigned to IGB therapy as compared to conventional non-surgical therapy in RCTs: mean difference (MD) in fasting glucose change: -12.7 mg/dl (95% confidence interval (CI) -21.5, -4); MD in triglycerides: -19 mg/dl (95% CI -42, 3.5); MD in waist circumference: -4.1 cm (95% CI -6.9, -1.4); MD in diastolic blood pressure: -2.9 mm Hg (95% CI -4.1, -1.8). The odds ratio for diabetes resolution after IGB therapy was 1.4 (95% CI 1.3, 1.6). The rate of serious adverse events was 1.3%.ConclusionsIGBs are more effective than diet in improving obesity-related metabolic risk factors with a low rate of adverse effects, however the strength of the evidence is limited given the small number of participants and lack of long-term follow-up.

Effect of Aspiration Therapy on Obesity-Related Comorbidities: Systematic Review and Meta-Analysis

“…Specifically, Popov et al conducted a meta-analysis of 40 studies with 5,668 patients who underwent IGB placement. 14 The study showed significant improvement in SBP by 9.1 mm Hg, DBP by 4.6 mm Hg, TG by 33.4 mg/dL, HbA1c by 0.6%, AST by 3 U/L, and ALT by 9 U/L at the time of IGB removal at 6 months, when data from observational studies were pooled. 14 More recently, Jirapinyo et al conducted a meta-analysis on 14 studies with 412 patients with obesity and concomitant T2DM who underwent DJBL.…”

Endoscopic bariatric and metabolic therapies: Another tool for the management of diabetes and obesity

“…Intragastric balloon placement allows for earlier interventions in obese patients who are not candidates for surgery and serves as a bridge to surgery in the morbidly obese . In addition, IGBs have proven useful in improving HbA1c, blood pressure, and weight circumference in those with metabolic syndrome …”

“…5 In addition, IGBs have proven useful in improving HbA1c, blood pressure, and weight circumference in those with metabolic syndrome. 5,7 Currently, three IGB systems have been FDA approved for weight loss and are commercially available in the US: the Orbera Intragastric Balloon System (Apollo Endosurgery, Austin, Texas), the ReShape Integrated Dual Balloon System (ReShape Medical, San Clemente, California), and the Obalon Balloon System (Obalon Therapeutics, Carlsbad, California).…”

Aktuelle endoskopische Methoden in der Adipositas- und metabolischen Chirurgie

“…In einer Metaanalyse von 9 Studien mit insgesamt 267 Patienten betrug die mittlere Differenz des BMI − 3,4 (95 %-KI − 3,5 -− 3,24; p < 0,05) und der mittlere EWL 11,25 % (95 %-KI 10,61-11,89; p < 0,05) [12].…”

“…Der Einsatz von wassergefüllten Ballonsystemen zeigt hinsichtlich der Gewichtsreduktion deutlich bessere Ergebnisse [12,13]. Daten zum optimalen Zeitpunkt der Ballonexplantation 3 vs. 6 Monate existieren in der Literatur nicht.…”