The role of endoscopic therapy in obesity management: intragastric balloons and aspiration therapy

Abstract

Weight management is increasingly incorporating endoscopic bariatric therapy (EBT). As the global burden of obesity and its comorbidities has increased, it is evident that novel therapeutic approaches will be necessary to address the obesity epidemic. EBTs offer greater efficacy than diet and lifestyle modification and lower invasiveness than bariatric surgery. The US Food and Drug Administration has approved two intragastric balloons and aspiration therapy for the treatment of obesity: Apollo Orbera is indicated for the treatment of Class I and Class II obesity, Re Shape Integrated Dual Balloon system is indicated for the same range with a comorbidity, and Aspire Bariatrics AspireAssist is approved for patients with a body mass index of 35–55 kg/m2. These devices have proven safe and effective in clinical trials and are gaining commercial acceptance in the USA; the Orbera has been used extensively outside the USA for over 20 years. These devices will need to be delivered in the context of a multidisciplinary weight loss program, integrating comprehensive care of obesity. Patient selection is important, and ensuring appropriate patient expectations and understanding of alternatives such as pharmacologic therapy and surgery is essential. With several EBTs on the horizon, patients with obesity will have an even broader array of safe and effective options for weight management in the future.

Standardization of Bariatric Metabolic Procedures: World Consensus Meeting Statement

“…25) Origin, Advantages The AspireAssist® (Aspire Bariatrics, King of Prussia, PA), FDA approved in 2016, facilitates gastric aspiration therapy, in which food is removed from the stomach through an endoscopic gastrostomy aspiration tube through a skin port. The aspiration tube is endoscopically inserted; after 1-2 weeks, the external port is connected [205]. The objective of temporary or longer-term placement of the AspireAssist, beyond immediate postmeal calorie removal, is to induce long-term behavioral changes that decrease food intake and improve food choices to treat and prevent obesity.…”

Exclusively endoscopic approach to treating gastric perforation caused by an intragastric balloon: case series and literature review

“…Perforation can lead to peritoneal complications, which can be lethal 31 . Because there is limited evidence in the literature regarding the durability and efficacy of IGBs, the available studies having certain limitations, it is recommended that an IGB not be left in place for more than 6 months 3 23 32 . However, that time frame is not absolute, because most reported cases of IGB-induced perforation have occurred during the first 6 months after insertion of the device 32 , as in all three of the cases described in the current study.…”

“…Obesity is a serious disease, resulting in significant morbidity and mortality 1 . There are a number of measures to facilitate weight loss, ranging from dietary changes to endoscopic and surgical procedures 2 3 .…”

Hidden dangers and updated labels on gastric balloons

“…15 Early retrieval of the IGB under conscious sedation or general anesthesia has resulted in aspiration pneumonia, perforation or mucosal tears within the esophagus, ulcers within the gastroesophageal junction, and pneumonitis. 7,16,17 Pancreatitis is an increasingly recognized complication of IGB insertion and generally occurs within 1-year post-IGB insertion. 18 It is unknown whether continuous pressure on the pancreas occurs from the outset or only once the balloon settles into T A B L E 1 Characteristics, safety, and efficacy of various intragastric balloons 1,2,5,[9][10][11]13,22,23…”