The American Gastroenterological Association (AGA) has released new clinical guidelines recommending the use of intragastric balloons (IGB) for patients with obesity who have not been able to lose weight with traditional weight-loss strategies. This treatment is most successful with accompanying therapy, such as lifestyle modifications and pharmacological agents, and can be used in a sequential manner or along with bariatric surgery. These guidelines, ‘AGA Clinical Practice Guidelines on Intragastric Balloons in the Management of Obesity’, were published in Gastroenterology.
"Endoscopic bariatric therapies have evolved as an attractive tool for weight loss, however, less than 5% of patients with obesity seeking a weight loss therapy are aware of endoscopic weight loss options," said lead author, Dr Thiruvengadam Munirajfrom Yale University School of Medicine, New Haven, Connecticut. "Our hope is that this new guideline can lead to shared decision making between patients and providers to determine if intragastric balloons are the best weight loss option for that individual patient."
With the exception of acknowledgement that fluid-filled balloons may be associated with higher efficacy but lower tolerability than air-filled balloons, the guideline makes no recommendations on specific devices.
Key guideline recommendations include:
Patients with obesity seeking a weight loss intervention should consider using intragastric balloon therapy to augment the effect of moderate to high intensity lifestyle modifications.
To minimise gastrointestinal bleeding risk, treat patients undergoing IGB therapy with proton pump inhibitors (PPIs).
To avoid nausea, sedate patients for the IGB placement with anaesthetics associated with low incidence of nausea and continue anti-nausea medication for two weeks.
While screening for nutritional deficiencies is not needed, providing 1-2 multivitamins after IGB placement is suggested.
To keep weight off after IGB removal, AGA recommends dietary interventions, pharmacotherapy, repeat IGB or bariatric surgery. The choice of this maintenance strategy should be determined based on a shared decision-making approach.
"Shared decision making is a critical component of obesity therapy - for everything from selecting the right IGB device to what concomitant lifestyle modifications, pharmacotherapy or sequential procedures a patient should pursue,” added Muniraj. “This shared decision making should consider the patient's values and preferences, balance benefits and harms within the patient's clinical and behavioural context, and consider cost and availability.”
The guidelines acknowledge the limitations of the available evidence on IGBs, as well as the potential confounding based on IGB characteristics, RCT design and geographic variations of included studies. Nevertheless, data supports the efficacy and safety of IGBs for patients with obesity.
The AGA noted that new evidence may emerge in the future that might strengthen or modify some of the recommendations for the use of IGB in management of obesity. Therefore, the guidelines will be updated when major new research is published and the need for an update will be determined no later than 2022.
To access these guidelines, please click here