Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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.
Similar content being viewed by others
Abbreviations
- BMI:
-
Body mass index
- CI:
-
Confidence interval
- EBTs:
-
Endoscopic bariatric therapies
- EWL:
-
Excess weight loss
- FDA:
-
Food and Drug Administration
- IGBs:
-
Intragastric balloons
- RCT:
-
Randomized controlled trial
- SAE:
-
Serious adverse events
- US:
-
United States
References
Flegal KM, Carroll MD, Kit BK, et al. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012;307(5):491–7.
Finkelstein EA, Trogdon JG, Cohen JW, et al. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff. 2009;28(5):w822–w31.
Vargas EJ, Rizk M, Bazerbachi F, et al. Medical devices for obesity treatment: endoscopic bariatric therapies. Med Clin North Am. 2018;102(1):149–63.
Bazerbachi F, Vargas Valls EJ, Abu Dayyeh BK. Recent clinical results of endoscopic bariatric therapies as an obesity intervention. Clin Endosc. 2017;50(1):42–50.
Cummings DE, Overduin J. Gastrointestinal regulation of food intake. J Clin Investig. 2007;117(1):13.
Gómez V, Woodman G, Abu Dayyeh BK. Delayed gastric emptying as a proposed mechanism of action during intragastric balloon therapy: results of a prospective study. Obesity. 2016;24(9):1849–53.
Cipriani A, Higgins JP, Geddes JR, et al. Conceptual and technical challenges in network meta-analysis. Ann Intern Med. 2013;159(2):130–7.
Hutton B, Salanti G, Chaimani A, et al. The quality of reporting methods and results in network meta-analyses: an overview of reviews and suggestions for improvement. PLoS One. 2014;9(3):e92508.
Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8(5):336–41.
Jansen JP, Fleurence R, Devine B, et al. Interpreting indirect treatment comparisons and network meta-analysis for health-care decision making: report of the ISPOR Task Force on Indirect Treatment Comparisons Good Research Practices: part 1. Value Health. 2011;14(4):417–28.
Huwaldt JA. Plot Digitizer 2.4. 1. Free software distributed from: http://sourceforge.net/projects/plotdigitizer. 2005.
Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.
White IR, Barrett JK, Jackson D, et al. Consistency and inconsistency in network meta-analysis: model estimation using multivariate meta-regression. Res Synth Methods. 2012;3(2):111–25.
Dias S, Welton N, Caldwell D, et al. Checking consistency in mixed treatment comparison meta-analysis. Stat Med. 2010;29(7–8):932–44.
Salanti G, Ades A, Ioannidis JP. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol. 2011;64(2):163–71.
Puhan MA, Schunemann HJ, Murad MH, et al. A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis. BMJ. 2014;349:g5630.
Brignardello-Petersen R, Bonner A, Alexander PE, et al. Advances in the GRADE approach to rate the certainty in estimates from a network meta-analysis. J Clin Epidemiol. 2018;93:36–44.
Lindor KD, Hughes Jr RW, Ilstrup DM, et al. Intragastric balloons in comparison with standard therapy for obesity—a randomized, double-blind trial. Mayo Clin Proc. 1987;62(11):992–6.
Benjamin SB, Maher KA, Cattau Jr EL, et al. Double-blind controlled trial of the Garren-Edwards gastric bubble: an adjunctive treatment for exogenous obesity. Gastroenterology. 1988;95(3):581–8.
Hogan RB, Johnston JH, Long BW, et al. A double-blind, randomized, sham-controlled trial of the gastric bubble for obesity. Gastrointest Endosc. 1989;35(5):381–5.
Ramhamadany EM, Fowler J, Baird IM. Effect of the gastric balloon versus sham procedure on weight loss in obese subjects. Gut. 1989;30(8):1054–7.
Rigaud D, Trostler N, Rozen R, et al. Gastric distension, hunger and energy intake after balloon implantation in severe obesity. Int J Obes Relat Metab Disord. 1995;19(7):489–95.
Mathus-Vliegen EMH, Tytgat GNJ. Intragastric balloon for treatment-resistant obesity: safety, tolerance, and efficacy of 1-year balloon treatment followed by a 1-year balloon-free follow-up. Gastrointest Endosc. 2005;61(1):19–27.
Genco A, Cipriano M, Bacci V, et al. BioEnterics Intragastric Balloon (BIB): a short-term, double-blind, randomised, controlled, crossover study on weight reduction in morbidly obese patients. Int J Obes. 2006;30(1):129–33.
Martinez-Brocca MA, Belda O, Parejo J, et al. Intragastric balloon-induced satiety is not mediated by modification in fasting or postprandial plasma ghrelin levels in morbid obesity. [Erratum appears in Obes Surg. 2007 Jul;17(7):996]. Obes Surg. 2007;17(5):649–57.
Konopko-Zubrzycka M, Baniukiewicz A, Wroblewski E, et al. The effect of intragastric balloon on plasma ghrelin, leptin, and adiponectin levels in patients with morbid obesity. J Clin Endocrinol Metab. 2009;94(5):1644–9.
De Castro ML, Morales MJ, Del Campo V, et al. Efficacy, safety, and tolerance of two types of intragastric balloons placed in obese subjects: a double-blind comparative study. Obes Surg. 2010;20(12):1642–6.
Genco A, Cipriano M, Bacci V, et al. Intragastric balloon followed by diet vs intragastric balloon followed by another balloon: a prospective study on 100 patients. Obes Surg. 2010;20(11):1496–500.
Farina MG, Baratta R, Nigro A, et al. Intragastric balloon in association with lifestyle and/or pharmacotherapy in the long-term management of obesity. Obes Surg. 2012;22(4):565–71.
Giardiello C, Borrelli A, Silvestri E, et al. Air-filled vs water-filled intragastric balloon: a prospective randomized study. Obes Surg. 2012;22(12):1916–9.
Lee Y-M, Low HC, Lim LG, et al. Intragastric balloon significantly improves nonalcoholic fatty liver disease activity score in obese patients with nonalcoholic steatohepatitis: a pilot study. Gastrointest Endosc. 2012;76(4):756–60.
Fuller NR, Pearson S, Lau NS, et al. An intragastric balloon in the treatment of obese individuals with metabolic syndrome: a randomized controlled study. Obesity. 2013;21(8):1561–70.
Genco A, Dellepiane D, Baglio G, et al. Adjustable intragastric balloon vs non-adjustable intragastric balloon: case-control study on complications, tolerance, and efficacy. Obes Surg. 2013;23(7):953–8.
Mohammed MA, Anwar R, Mansour AH, et al. Effects of intragastric balloon versus conservative therapy on appetite regulatory hormones in obese subjects. Trends Med Res. 2014;9(2):58–80.
Ponce J, Woodman G, Swain J, et al. The REDUCE pivotal trial: a prospective, randomized controlled pivotal trial of a dual intragastric balloon for the treatment of obesity. Surg. 2015;11(4):874–81.
Dargent J, Angella S, Pontette F. Post-operative trajectories in bariatric patients: comprehensive analysis of a consecutive series with an original endoscopic method over two years. Obesite. 2016;11(1):39–46. French
Courcoulas A, Abu Dayyeh BK, Eaton L, et al. Intragastric balloon as an adjunct to lifestyle intervention: a randomized controlled trial. Int J Obes. 2017;41(3):427–33.
Sullivan S, Swain JM, Woodman G. The Obalon swallowable 6-month balloon system is more effective than moderate intensity lifestyle therapy alone: results from a 6-month randomized sham controlled trial. Gastroenterology. 2016;150(4 Suppl 1):S1267.
Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. N Engl J Med. 2017;376(3):254–66.
Ikramuddin S, Korner J, Lee W-J, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA. 2013;309(21):2240–9.
Ponce J, Nguyen NT, Hutter M, et al. American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in the United States, 2011-2014. Surg Obes Relat Dis. 2015;11(6):1199–200.
Watt KD, Heimbach J, Rizk M, et al., editors. Endoscopic intragastric balloon placement for weight loss in liver transplant candidates. Hepatology. Hoboken: Wiley; 2017.
Mathus-Vliegen E, Eichenberger R. Fasting and meal-suppressed ghrelin levels before and after intragastric balloons and balloon-induced weight loss. Obes Surg. 2014;24(1):85–94.
Delgado-Aros S, Camilleri M, Castillo EJ, et al. Effect of gastric volume or emptying on meal-related symptoms after liquid nutrients in obesity: a pharmacologic study. Clin Gastroenterol Hepatol. 2005;3(10):997–1006.
Vargas EJ, Pesta CM, Bali A, et al. Single fluid-filled intragastric balloon safe and effective for inducing weight loss in a real-world population. Clin Gastroenterol Hepatol. 2018. https://doi.org/10.1016/j.cgh.2018.01.046.
FDA. Liquid-filled intragastric balloon systems: letter to healthcare providers—potential risks. U.S. Food & Drug Administration.; 2017 [updated 08/10/20171/22/2018]; Available from: https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm570916.htm.
Maisel W. The FDA alerts health care providers about potential risks with liquid-filled intragastric balloons. U.S. Food & Drug Administration.; 2017 [1/22/2018]; Available from: https://www.fda.gov/MedicalDevices/ResourcesforYou/HealthCareProviders/ucm540655.htm.
Dayyeh BKA, Kumar N, Edmundowicz SA, et al. ASGE Bariatric Endoscopy Task Force systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting endoscopic bariatric therapies. Gastrointest Endosc. 2015;82(3):425–38. e5.
Buchwald H, Estok R, Fahrbach K, et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142(4):621–35.
Neto MG, Silva LB, Grecco E, et al. Brazilian Intragastric Balloon Consensus Statement (BIBC): practical guidelines based on experience of over 40,000 cases. Surg Obes Relat Dis. 2017.
Author information
Authors and Affiliations
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.
Corresponding author
Ethics declarations
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.
Electronic Supplementary Material
Rights and permissions
About this article
Cite this article
Bazerbachi, F., Haffar, S., Sawas, T. et al. Fluid-Filled Versus Gas-Filled Intragastric Balloons as Obesity Interventions: a Network Meta-analysis of Randomized Trials. OBES SURG 28, 2617–2625 (2018). https://doi.org/10.1007/s11695-018-3227-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-018-3227-7