Obesity Surgery

, Volume 28, Issue 9, pp 2617–2625 | Cite as

Fluid-Filled Versus Gas-Filled Intragastric Balloons as Obesity Interventions: a Network Meta-analysis of Randomized Trials

  • Fateh Bazerbachi
  • Samir Haffar
  • Tarek Sawas
  • Eric J. Vargas
  • Ravinder Jeet Kaur
  • Zhen Wang
  • Larry J. Prokop
  • M. Hassan Murad
  • Barham K. Abu Dayyeh
Original Contributions



Four commercially available intragastric balloons have been used for the management of obesity and underwent randomized controlled trials (RCTs), and we aimed to compare them using a network meta-analysis approach.


Several databases were queried from inception to May 26, 2017, and we included RCTs enrolling patients treated with Orbera, Heliosphere, ReShape Duo, and Obalon compared with another balloon, sham, or open-label control group. Two investigators independently abstracted data. A random effects frequentist network meta-analysis and relative ranking of agents using surface under the cumulative ranking probabilities were performed.


We included 15 trials at low risk of bias (only two were head-to-head). Compared to control groups, the two fluid-filled devices were associated with significant outcome (% total body weight loss) at 6 months: Orbera, 6.72% (95% CI, 5.55, 7.89) and ReShape Duo 4% (95% CI 2.69, 5.31). Only one of the two gas-filled devices was associated with significant outcome at 6 months: Obalon 3.3% (95% CI 2.30, 4.30), and not the second: Heliosphere 6.71% (95% CI − 0.82, 14.23). Fluid-filled devices had the highest likelihood of superiority in achieving the outcome at 6 months (96.8%) and at 12 months (96.6%). The quality of evidence was high for comparisons against control.


Fluid-filled balloons are more likely to produce weight loss compared to gas-filled balloons or lifestyle intervention. However, they may be associated with a higher rate of intolerance and early removal. This information will aid clinicians in device selection and engaging patients in shared decision-making.


Weight loss Bariatric endoscopic therapies Therapeutic endoscopy 



Body mass index


Confidence interval


Endoscopic bariatric therapies


Excess weight loss


Food and Drug Administration


Intragastric balloons


Randomized controlled trial


Serious adverse events


United States


Author Contributions

Fateh Bazerbachi MD, Samir Haffar MD, M. Hassan Murad MD, MPH, and Barham K. Abu Dayyeh MD, MPH, contributed to the study concept and design, interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, and study supervision. Tarek Sawas, Ravinder Jeet Kaur, and Eric J. Vargas contributed to the data acquisition and critical revision of the manuscript for important intellectual content. Larry J. Prokop contributed to the librarian search and critical revision of the manuscript for important intellectual content. Zhen Wang contributed to the statistical analysis and critical revision of the manuscript for important intellectual content.

Compliance with Ethical Standards

Ethical Approval

For this type of study, formal consent is not required.

Conflict of Interest

Fateh Bazerbachi: none, Samir Haffar: none, Tarek Sawas: none, Eric J. Vargas: none, Ravinder Jeet Kaur: none, Zhen Wang: none, Larry Prokop: none, M. Hassan Murad: none, Barham K. Abu Dayyeh received research grants by Spatz Medical and Apollo Endosurgery.

Supplementary material

11695_2018_3227_MOESM1_ESM.docx (43 kb)
ESM 1 (DOCX 43.4 kb)
11695_2018_3227_Fig5_ESM.gif (105 kb)
Supplemental Fig. 1

(GIF 104 kb)

11695_2018_3227_MOESM2_ESM.tif (227 kb)
High Resolution Image (TIFF 227 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Fateh Bazerbachi
    • 1
  • Samir Haffar
    • 2
  • Tarek Sawas
    • 1
  • Eric J. Vargas
    • 1
  • Ravinder Jeet Kaur
    • 1
  • Zhen Wang
    • 3
  • Larry J. Prokop
    • 4
  • M. Hassan Murad
    • 3
  • Barham K. Abu Dayyeh
    • 1
  1. 1.Division of Gastroenterology and HepatologyMayo ClinicRochesterUSA
  2. 2.Digestive Center for Diagnosis and TreatmentDamascusSyrian Arab Republic
  3. 3.Mayo Clinic Evidence-based Practice Center, Mayo ClinicRochesterUSA
  4. 4.Department of Library ServicesMayo ClinicRochesterUSA

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