Intragastric balloon therapy in the management of obesity: why the bad wrap?

For the first time in the history of the United States, in the 21st century, there may be a decline in life expectancy, as a result of the increasing rate of obesity. It is known that even the modest reduction of 10% of excess body weight significantly reduces obesity-associated comorbidities. Conservative measures such as diet and exercise seldom give durable results in the long term. Bariatric surgery has been shown to achieve durable weight loss but is not without significant risks and complications. As a result, greater focus has turned toward minimally invasive endoscopic therapies for the management of obesity. There have been multiple reports of creative endoscopic devices and techniques in the literature, but most have only demonstrated early pilot data. By far, the most widely studied of the minimally invasive endoscopic therapies for obesity is the gastric balloon. Now obsolete, the Garren-Edwards gastric bubble was removed from the market in the United States after several sham-controlled studies showed that diet and behavior modification were equally efficacious and that the device was associated with a prohibitive number of complications. However, the concept and technique of intragastric balloon placement has evolved considerably since that time, and we now have data on nearly 3,000 patients who have undergone placement of the BioEnterics Intragastric Balloon (Carpenteria, CA) worldwide. The balloon is approved as part of a multifaceted approach to obesity in many countries and has been shown to result in at least a 10% excess weight loss durable over 1 year. However, the device is not yet approved for use in the United States. In this article, the authors review the efficacy, indications, complications, and potential uses for the intragastric balloon. The intragastric balloon might be the best start as gastroenterologists in the United States begin to play an increasing role in the treatment of the obesity pandemic.