INTRODUCTION — More than 1.4 billion adults worldwide are overweight or obese. Such individuals often develop health conditions such as diabetes, hypertension, and heart disease. A modest weight loss of 5 to 10 percent may be sufficient to delay or prevent the onset of diabetes and other obesity-related illnesses [1-3].
However, safe and effective weight loss therapies are not accessible to everyone, nor is every patient an appropriate candidate [4]. Intragastric balloon therapy is a minimally invasive, temporary method of inducing weight loss. It relies upon a soft saline- or air-filled balloon(s) placed in the stomach to promote the feeling of satiety and restriction (figure 1).
The weight loss mechanism of intragastric balloon therapy is by restriction and likely by a change in gut motility. Any balloon with a volume of 400 mL or greater can induce satiety [5]. Another possible mechanism of action that may contribute to weight loss is by the balloon causing a delay in gastric emptying [6,7], which has been shown to correlate with weight loss. As with any bariatric procedure, the patient's compliance with lifestyle modifications is essential for achieving and sustaining weight loss during and after therapy.
The indications for intragastric balloon therapy, choices of available balloons, potential adverse effects, and strategies of maintaining weight loss after balloon removal are discussed in this topic. Other methods of achieving weight loss are discussed separately. (See "Obesity in adults: Overview of management" and "Bariatric procedures for the management of severe obesity: Descriptions".)
INDICATIONS — The initial management of obesity is with lifestyle intervention. All patients who would benefit from weight loss should receive counseling on diet, exercise, sleep, and goals for weight loss. (See "Obesity in adults: Overview of management".)
Intragastric balloon therapy is an option for patients with a body mass index (BMI) of greater than 27 kg/m2 in Europe or 30 kg/m2 in the United States (US) who have tried and failed previous attempts at weight management with lifestyle changes alone [8-10].
It remains open where intragastric balloon therapy falls in the algorithm for patients with obesity seeking to lose weight (eg, whether it can be used alone, sequentially, with concomitant therapies, or as a bridge to longer-term weight-loss interventions, such as bariatric surgery) [8]. For those who qualify for bariatric surgery, the provider should explain the efficacy and risk of both options and help the patient reach a decision based on their values and preferences (ie, shared decision making).
CONTRAINDICATIONS — Patients seeking intragastric balloon therapy should be screened for potential contraindications with a complete history focusing on gastrointestinal disorders, a physical examination, and radiologic studies (when necessary). Strict adherence to these contraindications helps to limit serious adverse events and maximize patient satisfaction.
Absolute contraindications to intragastric balloon therapy include [11]:
●Previous gastric surgery
●Coagulation disorders (see "Preoperative assessment of hemostasis")
●Actively bleeding lesion in the upper gastrointestinal tract (see "Causes of upper gastrointestinal bleeding in adults")
●Pregnancy or desire to become pregnant
●Alcoholism or drug addiction
●Severe liver disease (see "Hemostatic abnormalities in patients with liver disease")
●Contraindications to endoscopy (see "Overview of upper gastrointestinal endoscopy (esophagogastroduodenoscopy)", section on 'Patient selection')
Relative contraindications to intragastric balloon therapy include [11]:
●Previous abdominal surgery
●Large hiatal hernia (see "Hiatus hernia")
●Inflammatory bowel disease (see "Clinical manifestations, diagnosis, and prognosis of ulcerative colitis in adults" and "Clinical manifestations, diagnosis, and prognosis of Crohn disease in adults")
●Chronic nonsteroidal anti-inflammatory drug (NSAID) use (see "NSAIDs (including aspirin): Pathogenesis and risk factors for gastroduodenal toxicity")
●Uncontrolled psychiatric disorders
TYPES OF INTRAGASTRIC BALLOONS — Intragastric balloons differ in material, volume, duration of therapy, adjustability, and method of insertion and removal (table 1).
Devices marketed in the US — Currently, there are two US Food and Drug Administration (FDA)-approved intragastric balloon devices that are marketed in the United States (US):
Orbera — The Orbera balloon is currently the most commonly used intragastric balloon in the US. It is made of silicone and placed in the stomach endoscopically and filled with 400 to 700 mL of saline. After residing in the stomach for six months, it is also removed endoscopically.
Obalon — The Obalon system consists of three separate balloons that are inserted by swallowing and filled with gas to 250 mL each via an attached catheter. One balloon is typically inserted every two to four weeks; at six months after insertion of the first balloon, all balloons are retrieved endoscopically. The multiple-balloon system is meant to tailor the feeling of restriction and prevent migration in case one balloon were to rupture.
Devices marketed outside the US — Other devices are currently only marketed outside the US for regulatory reasons:
Spatz — The Spatz adjustable balloon system utilizes a saline-filled balloon that can reside in the stomach for up to one year. The volume of the balloon is adjustable. The Spatz balloon is made of silicone and is inserted, adjusted (if necessary), and removed endoscopically. The Spatz balloon is currently FDA approved but cannot be marketed in the US until it has completed enrollment in its post-market approval study. (See 'Additional treatment after intragastric balloon therapy' below.)
Allurion — Allurion is a procedureless gastric balloon made from polyurethane that is swallowed by the patient before it is filled with 550 mL of saline through a thin catheter. After approximately four months, a resorbable material inside the balloon degrades to allow a release valve to open and the balloon to empty. The empty balloon is then excreted naturally. Allurion balloons may be desirable for patients who wish to avoid endoscopy and/or anesthesia [12-14]. Allurion is currently not FDA approved and therefore is only marketed outside the US.
EFFICACY OF INTRAGASTRIC BALLOONS
Weight loss
Initial weight loss — Intragastric balloons are capable of producing anywhere from 6 to 15 percent total body weight loss (TBWL), compared with the 1 to 5 percent TBWL produced through lifestyle interventions alone [15].
A meta-analysis of 55 studies including 6645 Orbera balloon implantations demonstrated a pooled estimate of TBWL of 12.3 (95% CI 7.91-16.73), 13.16 (95% CI 12.37-13.95), and 11.27 percent (95% CI 8.17-14.36) at 3, 6, and 12 months postimplantation [9].
The degree of weight loss that can be achieved may depend upon the balloon system used. Several meta-analyses found greater weight loss with fluid-filled than air-filled balloons [16,17]. However, the difference may be caused by pivotal study design (sham-controlled trial design suppressing weight loss in balloon patients). Furthermore, fluid-filled balloons are less well tolerated than gas-filled balloons and cause more complications. (See 'Adverse events' below.)
The degree of weight loss that can be achieved also depends upon geographic location. In North America, according to data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), patients lose approximately 10 percent of their total body weight at six months, half of which is during the first 30 days [18]. In Brazil, a study of over 40,000 procedures reported a mean percentage total weight loss of 18.4±2.9 percent [19].
Sustained weight loss — Although intragastric balloons are safe and effective in managing obesity for the short term, they are temporary measures, and weight regain is expected after their removal. In a study of 500 patients who underwent six months of treatment with intragastric balloon therapy, only one-half of the patients maintained 20 percent excess weight loss at one year after balloon removal, and one-quarter of patients kept this weight loss at five years [20]. At 10 years, there is not a difference between balloon therapy and lifestyle changes [21]. Consequently, many patients require additional treatment. (See 'Additional treatment after intragastric balloon therapy' below.)
Improvement in metabolic parameters — Intragastric balloon therapy has been shown to improve metabolic parameters in patients who successfully lose weight [22]. In a meta-analysis of 10 trials and 30 observational studies, there was moderate-quality, but mostly short-term, evidence for improvement in most metabolic parameters after intragastric balloon therapy as opposed to lifestyle intervention [23].
Although there are no long-term data, a sustained metabolic benefit is plausible given the large initial weight loss (up to 15 percent) achievable with intragastric balloon therapy. Post-hoc analysis of the look-AHEAD trial has found that, even with weight regain, an initial total body weight loss of 10 percent or more through intense lifestyle intervention was associated with long-term reduction in a composite cardiovascular endpoint [24] and that initial >8 percent total body weight loss at one year was associated with reduction in HbA1C at four years [25].
COMPARISON WITH OTHER WEIGHT LOSS THERAPIES — Lifestyle interventions and pharmacotherapy usually result in similar weight losses of 2 to 9 percent total body weight [26]. Intragastric balloon therapy can be expected to achieve an 8 to 15 percent total body weight loss (TBWL) in the short term, depending on the type of balloon used [27]. By comparison, bariatric surgery can achieve a TBWL of 13 (adjustable gastric band) to 30 percent (gastric bypass or sleeve gastrectomy) [28]. (See "Obesity in adults: Dietary therapy" and "Obesity in adults: Drug therapy" and "Outcomes of bariatric surgery", section on 'Initial weight loss' and "Outcomes of bariatric surgery", section on 'Durable weight loss'.)
However, irrespective of the method, some weight regain is expected after the initial weight loss. The choice of a weight loss therapy should not be determined by the degree of achievable weight loss alone, but also potential complications and cost.
Lifestyle intervention — The effectiveness of intragastric balloons plus lifestyle intervention in inducing weight loss is superior to lifestyle intervention alone in multiple "pivotal" trials, which largely constituted the bases for their Food and Drug Administration (FDA) approvals [8,29]:
●In a randomized trial of 255 patients comparing Orbera therapy with lifestyle interventions alone, the TBWL among those who completed Orbera for six months (n = 116) was 10.7±6.8 percent, compared with 4.7±5 percent in the control group (n = 99) [30].
●In a randomized sham-controlled trial of 387 patients at 15 United States centers (US), treatment with Obalon balloons resulted in greater weight loss (7.1±5.0 percent TBWL) than moderate-intensity lifestyle therapy (3.6±5.1 percent TBWL) [31].
●In a randomized trial of 288 patients at seven US centers, treatment with an adjustable balloon (Spatz) resulted in greater weight loss (15 percent TBWL [95% CI 13.9-16.1]) than lifestyle therapy (3.3 percent TBWL [95% CI 2.0-4.6]) at 32 weeks [32]. At six months after balloon removal, 74 percent maintained at least 40 percent of the weight lost at the time of balloon removal.
●The REDUCE pivotal trial reported similar results with a dual balloon system [33]. However, that balloon system (Reshape) is no longer marketed.
Pharmacotherapy — In general, the extent of weight loss achieved in the short term through intragastric balloon therapy compares favorably with pharmacotherapy [26,27]. The only randomized trial compared the BIB balloon (currently known as Orbera) and sibutramine, which is no longer on the market. Initial weight loss at six months was greater in the balloon group (14.5 versus 9.1 percent total body weight) [34].
However, one study reported that intragastric balloon therapy generally produces a control-subtracted percent TBWL over 6 months of 5.5 to 5.6 percent, which is less than the most efficacious FDA-approved weight loss drug, phentermine and topiramate (Qsymia) [35]. At the recommended dose, Qsymia has a placebo-subtracted percent TBWL at 6 months of approximately 6.6 percent. Direct comparative studies are required to determine if intragastric balloon therapy is more or less effective than weight loss drugs. (See "Obesity in adults: Drug therapy", section on 'Phentermine-topiramate'.)
It should be noted that, in clinical practice, weight loss medications may be less effective than in clinical trials due to low adherence. As an example, in an analysis of over 44,000 patients who were on anti-obesity medications, only 7.2 to 28.2 percent were still filling their prescriptions at 12 months [36].
Surgical therapies — In a retrospective study of over 65,000 patients in the National Patient-Centered Clinical Research Network (PCORnet), one-year mean percent TBWL was 31.2 percent (95% CI 31.1-31.3) for gastric bypass, 25.2 percent (95% CI 25.1-25.4) for sleeve gastrectomy (SG), and 13.7 percent (95% CI 13.3-14.0) for adjustable gastric band; five-year mean percent TBWL was 25.5 percent (95% CI 25.1-25.9) for gastric bypass, 18.8 percent (95% CI 18.0-19.6) for sleeve gastrectomy, and 11.7 percent (95% CI 10.2-13.1) for adjustable gastric band [28]. (See "Bariatric procedures for the management of severe obesity: Descriptions", section on 'Procedures endorsed by the ASMBS'.)
ADVERSE EVENTS — The safety profile of intragastric balloons differs depending on whether they are fluid or gas filled and endoscopically placed or swallowed. In general, gas-filled balloon systems are better tolerated than fluid-filled systems, and swallowable balloon systems cause fewer serious complications and death than endoscopically placed balloons [8]. Therefore, the diet and medical management of common symptoms after intragastric balloon placement differs based on the balloon.
However, all patients treated with intragastric balloons should undergo testing and, if necessary, treatment for Helicobacter pylori prior to balloon placement, and all patients should receive proton pump inhibitor therapy while the balloon is in place to reduce the risk of gastric ulceration.
Fluid-filled endoscopically placed balloons — Currently, the most common intragastric balloon used in the United States (US) is a fluid-filled and endoscopically placed balloon (Orbera Intragastric Balloon).
In a retrospective analysis of over 1000 procedures performed between 2016 and 2017, 7.2 percent of patients required treatment for dehydration, 2.0 percent required readmission, 1.1 percent required reoperation, and 6.2 percent required intervention within 30 days [18]. In another study of over 145,000 patients, intragastric balloon therapy was associated with a higher adverse event rate than laparoscopic bariatric surgery (odds ratio 1.97, 95% CI 1.10-3.52) due to a significantly higher nonoperative reintervention rate (4.2 versus 1.0 percent) [37].
Common adverse events — At the beginning of intragastric balloon therapy, up to 91 percent of patients will develop some form of gastrointestinal symptoms due to gastric accommodation to the balloon [38]. Typical symptoms include nausea, vomiting, abdominal pain, acid reflux, burping, dyspepsia, and constipation [39].
A variety of medications can be used to control these symptoms. Patients are typically started on a proton pump inhibitor before balloon insertion and prescribed a three- to five-day course of an antiemetic (eg, ondansetron or aprepitant) and an anticholinergic (eg, scopolamine [hyoscine] butylbromide) to be used during the first week of therapy [8].
Early balloon removal may be necessary if symptoms persist [11,40]. However, very few patients (4 to 7 percent) continue to experience significant gastrointestinal symptoms after the first week of therapy, and even fewer events (<3 percent) required endoscopic reintervention or early balloon removal [38].
Serious adverse events — Serious adverse events are rare, with an incidence of balloon migration, gastric perforation, and mortality of 1.4, 0.1, 0.08 percent, respectively, in one meta-analysis [9]. Serious adverse events may be related to either the balloon or the procedure.
Balloon-related serious adverse events — Serious adverse events that can result from all balloon systems include balloon migration, gastric or esophageal perforation, and gastric ulceration. Serious adverse events that are largely unique to liquid-filled balloons include spontaneous hyperinflation and acute pancreatitis [41].
●Balloon migration – Intragastric balloons left in the stomach longer than the intended duration of therapy are at risk of rupturing and migrating into the intestine. While most migrated balloons were excreted successfully, some caused intestinal obstructions [42-44]. Thus, patients should be followed closely to ensure timely balloon removal, which reduces the risk of balloon migration and intestinal obstruction.
Many of the balloons are filled with saline that is dyed blue. If a rupture occurs, the patient's urine may turn blue or green because the spilled dye is absorbed and then excreted by the kidneys. This mechanism warns the patient that the balloon has ruptured, so it can be retrieved before it migrates and causes bowel obstruction.
A multi-balloon platform may have an advantage over a single-balloon design. In a case where one balloon ruptures, the second balloon can prevent migration.
●Spontaneous hyperinflation – Hyperinflation involves the spontaneous filling of intragastric balloons with additional air or liquid while inside a patient's stomach, typically resulting in the need for early device removal. The US Food and Drug Administration (FDA) has received over 200 adverse event reports of hyperinflation worldwide since approving the liquid-filled balloons in 2015, with over 99 percent involving Orbera balloons [45].
●Acute pancreatitis – Acute pancreatitis may be caused by direct injury from the balloon and distended stomach exerting pressure on the pancreatic parenchyma and/or indirect pancreatic injury through duodenal obstruction. Although acute pancreatitis can develop with any type of balloon, clinically it has been observed mostly with liquid-filled balloons. The FDA has received nearly 30 adverse event reports of acute pancreatitis worldwide since approving the liquid-filled balloons in 2015, with two-thirds involving Orbera balloons [45].
Procedure-related serious adverse events — Most procedure-related serious adverse events occur during balloon removal, including esophageal tear, pneumonia, gastrointestinal bleeding, and esophageal perforation.
Balloon retrieval requires endoscopic equipment specific to each balloon. In general, though, it requires a needle to deflate the balloon and a sturdy grasper or snare to pull the balloon out. The endoscopist performing intragastric balloon insertion and removal must be properly trained to avoid procedure-related complications.
Mortality — The FDA has issued multiple letters to alert health care providers of 18 reported deaths worldwide from 2016 to present in patients with liquid-filled intragastric balloon systems used to treat obesity [45].
According to information from the FDA, 8 of the 18 deaths involved United States patients (five with the Orbera Intragastric Balloon System and three with the ReShape Integrated Dual Balloon System [withdrawn from market]), of which three deaths occurred following gastric perforation, two following pulmonary embolus, one following esophageal perforation, and two are unknown [45].
Although these 18 deaths have been reported since 2016, the incidence rate of death in those who received intragastric balloon therapy is not known. One systematic review published in 2016 showed a mortality rate of 0.05 percent, but that included many of the case series from the early 2000s [46]. A meta-analysis of randomized controlled trials published in 2015 reported a 0 percent mortality rate in 20 studies and almost 1200 patients, but only with a three-month follow-up [47]. The only study that reported its findings on intragastric balloons left in for more than six months reported no mortalities [48], though such practice is generally not recommended. (See 'Balloon-related serious adverse events' above.)
While the mortality may be low, we echo the FDA recommendation that patients be instructed and closely monitored for symptoms of potentially life-threatening complications [45]. (See 'Serious adverse events' above.)
Gas-filled or procedureless balloons — The Obalon balloon system, which is gas filled, has a lower serious adverse event rate of 0.15 to 0.3 percent [31,49]. In the US, no deaths or serious complications such as spontaneous hyperinflation or pancreatitis occurred with the Obalon balloon system. When the Obalon balloon system prematurely deflates, the patient may be alerted by stomach pain up to several days prior to the balloon migrating into the small bowel, caused by the stomach trying to compress the balloon through the pylorus.
Gas-filled balloons are generally better tolerated than fluid-filled ones. In a prospective registry of 1343 patients, common symptoms of nausea, vomiting, and abdominal pain occurred in 2.3 to 5.3 percent, and any gastrointestinal (GI) symptom occurred in 13.4 percent of patients [49]. Thus, only ondansetron and antispasmodics are required in patients receiving the Obalon balloon system for GI-related symptoms.
Allurion, which is a fluid-filled but procedureless balloon, has a reported serious adverse event rate of 0.53 percent in a 1770 patient series [13]. While the rate of serious adverse events with the procedureless balloon is similar to that of the gas-filled intragastric balloon, postplacement accommodative symptoms may be more similar to those of other fluid-filled balloons. Therefore, the postplacement medication regimen for placement of the procedureless fluid-filled balloon should be similar to that of the endoscopically placed fluid-filled balloon.
ADDITIONAL TREATMENT AFTER INTRAGASTRIC BALLOON THERAPY — Achieving and maintaining weight loss with any therapy is made difficult by the reduction in energy expenditure that is induced by weight loss. Recidivism, which is regaining of lost weight, is a common problem in treating obesity, including intragastric balloon therapy. (See 'Sustained weight loss' above.)
With continued diet and exercise, 50 percent of the weight loss achieved during intragastric balloon therapy can be maintained for at least one year after balloon removal [42]. Behavior modification strategies should be continued to minimize subsequent weight gain. (See "Obesity in adults: Behavioral therapy".)
Additional measures to sustain or augment weight loss after intragastric balloon therapy include pharmacotherapy, repeat balloon therapy, and bariatric surgery:
Pharmacotherapy — Weight loss medications (eg, sibutramine or liraglutide) have been shown to improve weight maintenance in individuals after intragastric balloon therapy [34,50]. The use of weight loss medications is discussed separately. (See "Obesity in adults: Drug therapy".)
Repeat balloon therapy — Intragastric balloon therapy may be repeated in patients who desire further weight loss after a mandatory one-month "balloon holiday." Studies showed that subsequent therapies are as effective as the initial treatment [51-53].
Patients who wish to undergo repeat intragastric balloon therapy should be evaluated individually. Those who were compliant with diet and exercise during the initial treatment are good candidates for retreatment; others are unlikely to benefit from repeat intragastric balloon therapy.
Adjustable balloon system — Multiple studies have demonstrated that 80 to 90 percent of weight loss is achieved during the first three to four months of intragastric balloon therapy, after which time the stomach accommodates and the restrictive effect is partially lost [42]. Thus, an increase in the balloon volume may induce more weight loss. (See 'Spatz' above.)
The Spatz adjustable balloon system permits the volume of the balloon to be adjusted. In a randomized trial, 70 percent of patients underwent adjustment of the balloon volume at four months (halfway point). This resulted in an additional 5.2 percent of total body weight loss (TBWL) between four and eight months. Patients who had the balloon volume adjusted had 3.1 percent greater TBWL than those who did not have any adjustment [32].
Conversely, individuals who experienced balloon intolerance benefited from downward adjustments. In the same trial discussed above, downward adjustment of the balloon volume allowed 75 percent of those patients to complete the 32 weeks of the study rather than undergo early balloon extraction [32]. Still, about 17 percent needed early extraction due to intolerance.
Bariatric surgery — Intragastric balloon therapy has been used in conjunction with bariatric surgery to induce weight loss safely in those with severe obesity. In one study, satisfactory results with Orbera were predictive of a good outcome with subsequent LAP-BAND surgery [54]. Weight loss achieved with presurgical balloon therapy also decreased the risk and complexity of bariatric surgery in individuals with a body mass index of greater than 50 kg/m2 [55]. (See 'Indications' above.)
However, the benefit of balloon therapy as a bridge to bariatric surgery may not be as dramatic as previously thought [56-58]. In a few trials comparing the use of balloon therapy versus control prior to bariatric surgery, although weight loss was greater, preoperative balloon therapy did not prevent postoperative complications and was associated with a 34 percent failure rate and a higher cost [59,60]. Further studies are needed to evaluate intragastric balloon therapy as a bridge therapy to another procedure [38].
SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: Bariatric surgery".)
SUMMARY AND RECOMMENDATIONS
●Mechanism of action – Intragastric balloon therapy entails placing a soft fluid- or gas-filled balloon in the stomach to promote a feeling of satiety and likely cause a delay in gastric emptying in order to induce weight loss (figure 1). Maximal weight loss with intragastric balloon therapy requires lifestyle therapy changes (ie, diet and exercise). (See 'Introduction' above.)
●Indications – Patients with a body mass index (BMI) of greater than 27 kg/m2 in Europe or 30 kg/m2 in the United States (US). Patients must have failed previous attempts at weight management with diet and exercise alone. (See 'Indications' above.)
●Contraindications (see 'Contraindications' above):
•Absolute – Previous gastric surgery, coagulation disorders, actively bleeding lesion in the gastrointestinal tract, pregnancy or desire to become pregnant, alcoholism or drug addiction, severe liver disease, or any contraindication to endoscopy.
•Relative – Previous abdominal surgery, large hiatal hernia, inflammatory bowel disease, chronic nonsteroidal anti-inflammatory drug use, or psychiatric disorders.
●Balloon types – Intragastric balloons differ in their volume, duration in the stomach, adjustability, and means of insertion and removal (table 1). Orbera and Obalon are marketed in the US, Spatz and Allurion are marketed outside the US, and the Spatz balloon will be marketed in the US once it has completed enrollment in the post-market approval study.
●Weight loss – Intragastric balloon therapy can achieve 8 to 15 percent total body weight loss (TBWL). By comparison, lifestyle interventions and pharmacotherapy usually result in 2 to 9 percent TBWL, and bariatric surgery can achieve 13 to 30 percent TBWL. (See 'Efficacy of intragastric balloons' above and 'Comparison with other weight loss therapies' above.)
●Adverse events – In general, gas-filled balloon systems are better tolerated than fluid-filled systems, and swallowable balloon systems cause fewer serious complications and deaths than endoscopically placed balloons. Currently, the most common intragastric balloon used in the US is a fluid-filled and endoscopically placed balloon (Orbera Intragastric Balloon). (See 'Adverse events' above.)
•Common – During the first week of intragastric balloon therapy, a majority of patients receiving a fluid-filled balloon will develop gastrointestinal symptoms due to gastric accommodation. The combination of a proton pump inhibitor, an antiemetic, and an anticholinergic helps most patients through the first week of therapy, after which time the symptoms greatly diminish.
•Serious – Serious adverse events (eg, balloon hyperinflation, migration, acute pancreatitis, or death) can, but rarely does, occur during intragastric balloon therapy and can be minimized by thorough patient education, closely monitoring for complications, timely balloon removal, and adequate training of endoscopists performing the procedure.
●Weight regain – Weight regain is expected after all methods of weight loss. With continued diet and exercise, 50 percent of the weight loss achieved during intragastric balloon therapy can be maintained for at least one year after balloon removal. Additional measures to sustain or augment weight loss after intragastric balloon therapy include weight loss medications, repeated balloon therapy after at least a one-month "balloon holiday," balloon volume adjustment (eg, with Spatz), or bariatric surgery. (See 'Additional treatment after intragastric balloon therapy' above.)
ACKNOWLEDGMENT — The UpToDate editorial staff acknowledges Ram Chuttani, MD, who contributed to an earlier version of this topic review.
