Intragastric balloon for high-risk super-obese patients: a prospective analysis of efficacy

Background: Super-obese patients with many co-morbidities present a challenge in bariatric surgery because of the high perioperative morbidity and mortality. The BioEnterics intragastric balloon (BIB) is an endoscopic device used preoperatively to induce weight loss to reduce the risk of surgery for morbid obesity. Methods: From November 2003 to April 2006, the BIB was endoscopically placed in 26 high-risk super-obese patients with a mean body mass index of 65.3 +/- 9.8 kg/m(2) and severe co-morbidities (mean 4.33 +/- 1.12, range 3-7). The BIB was endoscopically removed 6 months later, at which time the patients were evaluated in terms of weight loss and improvement of co-morbid conditions. Results: BIB placement was uneventful in all patients. The major side effect related to the procedure was occasional vomiting during the first 2 days (65%). One patient died (3.8%) of cardiac arrest after aspiration on the first postinsertion day as a direct result of BIB placement. The mean weight loss was 28.5 +/- 19.6 kg, and clinical re-evaluation revealed significant improvement in patient co-morbidity status (mean 2.23 +/- .7, range 1-3; P = .024). Twenty patients underwent a primary bariatric surgical procedure the day after BIB removal; 2 patients were rejected for surgery because of inadequate weight loss. Conclusions: BIB placement can be considered an effective first-stage treatment of high-risk super-obese patients in need of surgical intervention. Although not without risk, it is generally a simple procedure leading to satisfactory weight loss, improvement in co-morbidities, and consequent reduction of the perioperative mortality and morbidity rates associated with surgery. (Surg Obes Relat Dis 2007;3:78-83.) (C) 2007 American Society for Bariatric Surgery. All rights reserved.