Review of endoscopic devices for weight reduction: old and new balloons and implantable prostheses

Abstract

The worldwide epidemic of obesity is forecast to worsen with a concomitant increase in the burden of co-morbid conditions. Bariatric surgery has some disadvantages, and intragastric balloons (IGBs) represent a generally safe, reversible and less invasive approach to weight reduction, based on occupying gastric space to enhance the sensation of satiety. A literature review found that the majority of the published data on IGBs relates to the Bioenterics intragastric balloon (BIB). The evidence for the efficacy of the BIB as a primary means of weight loss is still unconvincing, but it appears to have value in subgroups of patients, for example to improve quality of life, ameliorate co-morbidities, or provide a bridge to surgery. Regarding other IGBs, even if there are promising weight loss results, more evidence and development is generally needed: it is difficult to evaluate the Heliosphere Bag because of the limited clinical experience; the Adjustable Totally Implantable Intragastric Prosthesis (ATIIP)-Endogast may have problems associated with the percutaneous endoscopic gastrotomy (PEG)-type insertion method; the Semistationary Antral Balloon (SAB) may require technical improvements; and the Silimed Gastric Balloon (SGB) warrants further investigation. Another implantable device, the endoscopic duodenal-jejunal sleeve is based on a different concept, that of mimicking bariatric surgery; it effectively bypasses the duodenum and jejunum, and shows promising results. Other endoscopically implantable devices, such as the ”Butterfly“ and tubular membranes are at an experimental stage.

References

• 1 Chaput J P, Tremblay A. Current and novel approaches to the drug therapy of obesity.  Eur J Clin Pharmacol. 2006;  62 793-803
• 2 Maggard M, Shugarman L, Suttorp M. et al . Meta-analysis: surgical treatment of obesity.  Ann Intern Med. 2005;  142 547-559
• 3 Kral J. ABC of obesity management: Part III – Surgery.  BMJ. 2006;  333 900-903
• 4 Cawley J, Sweeney M J, Kurian M. et al . New York State Bariatric Surgery Workgroup. Predicting complications after bariatric surgery using obesity-related co-morbidities.  Obes Surg. 2007;  17 1451-1456
• 5 Bonazzi P, Petrelli M D, Lorenzini I. Gastric emptying and intragastric balloon in obese patients.  Eur Rev Med Pharmacol Sci. 2005;  9 (5 Suppl 1) 15-21
• 6 Mion F, Napoleon B, Roman S. Effects of intragastric balloon on gastric emptying and plasma ghrelin levels in non-morbid patients.  Obes Surg. 2005;  15 510-516
• 7 Martinez-Brocca M A, Belda O, Parejo J. Intragastric balloon-induced satiety is not mediated by modification in fasting or postprandial plasma ghrelin levels in morbid obesity.  Obes Surg. 2007;  17 649-657
• 8 Mion F, Gincul R, Roman S. Tolerance and efficacy of an air-filled balloon in non-morbidly obese patients: results of a prospective multi-center study.  Obes Surg. 2007;  17 764-769
• 9 Puglisi F, Antonucci N, Zavoianni P L. et al . Intragastric balloon and binge eating.  Obes Surg. 2007;  17 504-509
• 10 Fernandes M, Atallah A N, Soares B GO. et al . Intragastric balloon for obesity.  Cochrane Database of Systemic Reviews. 2007;  1 CD004931
• 11 Mathus-Vliegen E M, Tytgat G N. Intragastric balloon for treatment-resistant obesity: safety, tolerance, and efficacy of 1-year balloon treatment followed by a 1-year balloon-free follow-up.  Gastointest Endosc. 2005;  61 19-26
• 12 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 (Lond). 2006;  30 129-133
• 13 Galloro G, Sivero L, Magno L. New technique for endoscopic removal of intragastric balloon placed for treatment of morbid obesity.  Obes Surg. 2007;  17 658-662
• 14 Imaz I, Martínez-Cervell C, García-Álvarez E E. et al . Safety and effectiveness of the intragastric balloon for obesity: a meta-analysis.  Obes Surg. 2008;  18 841-846
• 15 Van Hee R, Van Wiemeersch S, Lasters B. et al . Use of anti-emetics after intragastric balloon placement experience with three different drug treatments.  Obes Surg. 2003;  13 932-937
• 16 Genco A, Bruni T, Doldi S. et al . BioEnterics intragastric balloon: the Italian experience with 2515 patients.  Obes Surg. 2005;  15 1161-1164
• 17 Sallet J, Marchesini J, Paiva D. et al . Brazilian multicenter study of the intragastric balloon.  Obes Surg. 2004;  14 991-998
• 18 Hirsch D, Mathus-Vliegen E, Dagli U. et al . Effect of prolonged gastric distention on lower esophageal sphincter function and gastroesophageal reflux.  Am J Gastroenterol. 2003;  98 1696-1704
• 19 Hirsch D, Mathus-Vliegen E, Holloway R. et al . Lower esophageal sphincter function in morbidly obese subjects.  Dig Dis Sci. 2002;  47 2531-2537
• 20 Mui W L, Ng E K, Tsung B Y. et al . Impact on obesity-related illnesses and quality of life following intragastric balloon.  Obes Surg. ;  DOI 10.1007/s11695-008-9766-6
• 21 Busetto L, Enzi G, Inelmen E M. et al . Obstructive sleep apnea syndrome in morbid obesity. Effects of intragastric balloon.  Chest. 2005;  128 618-623
• 22 Ricci G, Bersani G, Rossi A. et al . Bariatric therapy with intragastric balloon improves liver dysfunction and insulin resistance in obese patients.  Obes Surg. 2008;  18 1438-1442
• 23 Melissas J, Malliaraki N, Papadakis J A. et al . Plasma antioxidant capacity in morbidly obese patients before and after weight loss.  Obes Surg. 2006;  16 314-320
• 24 Tarnoff M, Kaplan L, Shikora S. An evidenced-based assessment of preoperative weight loss in bariatric surgery.  Obes Surg. 2008;  18 1059-1061
• 25 Spyropoulos C, Katsakoulis E, Mead N. et al . Intragastric balloon for high-risk super-obese patients: a prospective analysis of efficacy.  Surg Obes Relat Dis. 2007;  3 78-83
• 26 Frutos M D, Morales M D, Lujan J. Intragastric balloon reduces liver volume in super-obese patients, facilitating subsequent laparoscopic gastric bypass.  Obes Surg. 2007;  17 150-154
• 27 Busetto L, Segato G, De Luca M. et al . Preoperative weight loss by intragastric balloon in super-obese patients treated with laparoscopic gastric banding: a case-control study.  Obes Surg. 2004;  14 671-676
• 28 Milone L, Strong V, Gagner M. Laparoscopic sleeve gastrectomy is superior to endoscopic intragastric balloon as a first stage procedure for super-obese patients (BMI > or = 50).  Obes Surg. 2005;  15 612-617
• 29 Loffredo A, Cappuccio M, De Luca M. et al . Three years experience with the new intragastric balloon and a preoperative test for success with restrictive surgery.  Obes Surg.. 2001;  11 330-333
• 30 De Goederen-van der Meij S, Pierik R G, Oudkerk Pool M. et al . Six months of balloon treatment does not predict the success of gastric banding.  Obes Surg. 2007;  17 88-94
• 31 Rutten S J, de Goederen-van der Meij S, Pierik R G. et al . Changes in quality of life after balloon treatment followed by gastric banding in severely obese patients – the use of two different quality of life questionnaires.  Obes Surg. DOI: DOI 10.1007/s11695-008-9732-3
• 32 Angrisani L, Lorenzo M, Borrelli V. Is bariatric surgery necessary after intragastric balloon treatment?.  Obes Surg. 2006;  16 1135-1137
• 33 Melissas J, Mouzas J, Filis D. et al . The intragastric balloon-smoothing the path to bariatric surgery.  Obes Surg. 2006;  16 897-902
• 34 De Peppo F, Di Giorgio G, Germani M. et al . BioEnterics intragastric balloon for treatment of morbid obesity in Prader-Willi syndrome: specific risks and benefits.  Obes Surg. 2008;  18 144-149
• 35 Forestieri P, De Palma G D, Formato A. Heliosphere bag in the treatment of severe obesity: preliminary experience.  Obes Surg. 2006;  16 635-637
• 36 Shastri Y, Haass S, Martin U. et al . Multicenter Study using air filled stomach balloon as a valid option for morbid obesity.  Gastrointest Endosc. 2007;  65 AB281
• 37 Gaggiotti G, Tack J, Garrido A B. et al . Adjustable totally implantable intragastric prosthesis (ATIIP)-Endogast for treatment of morbid obesity: one-year follow-up of a multicenter prospective clinical survey.  Obes Surg. 2007;  17 949-956
• 38 Lopasso F P, Sakai P, Gazi B M. et al . A pilot study to evaluate the safety, tolerance, and efficacy of a novel stationary antral balloon (SAB) for obesity.  J Clin Gastroenterol. 2008;  42 48-53
• 39 Carvalho G, Barros C, Okazaki M. et al . An improved intragastric balloon procedure using a new balloon: preliminary analysis of safety and efficiency.  Obes Surg. 2009;  19 237-242
• 40 Rodriguez-Grunert L, Galvao Neto M P, Alamo M. et al . First human experience with endoscopically delivered and retrieved duodenal-jejunal bypass sleeve.  Surg Obes Relat Dis. 2008;  4 55-59
• 41 Gersin K S, Keller J E, Stefanidis D. et al . Duodenal-jejunal bypass sleeve: a totally endoscopic device for the treatment of morbid obesity.  Surg Innov. 2007;  14 275-278
• 42 Hashiba K, Brasil H, Wada A. et al . Experimental study an alternative endoscopic method for the treatment of obesity: the butterfly technique.  Gastrointest Endosc. 2001;  53 ABll2
• 43 Hashiba K, Hassegawa R T, Wada S. et al . Plastic device (Butterfly) for endoscopic treatment of obesity: new design and operation.  Gastrointest Endosc. 2003;  57 AB181
• 44 Kelleher B, Stone C, Tsukashima R. et al . Implantation of a tubular membrane in the small intestine.  Gastrointest Endosc. 2004;  59 AB151