Introduction Obesity is a public health priority in the UK. Bariatric endoscopy falls between lifestyle interventions and surgical options, but few centres offer this service. Studies reporting weight loss outcomes and adverse events in patients receiving the intragastric balloon (IGB) are heterogeneous in design and location (1). We report outcomes from an IGB service at a London teaching hospital.
Method We conducted a retrospective analysis of consecutive IGB insertions between 01/09/2014 and 31/08/2016, using information held in the Electronic Patient Record. The primary outcome was weight loss at IGB removal, calculated in kilograms (kg). Secondary outcomes were premature removal (defined as IGB removal before 175 days) and emergency treatment (defined as emergency department attendance or hospital admission related to IGB). The paired t-test was used to compare weight before and after IGB. Univariable regression analyses were used to explore patient factors associated with each outcome. Complete case analyses were carried out where data were missing. Stata version 13.1 was used for all statistical analyses.
Results There were 172 IGB insertions in 127 patients; mean age 46.8 years, 73.3% female, and mean baseline weight 110 kg. 41% had previous experience of IGBs. Most were performed on a day case basis. Median time to IGB removal was 182 days (interquartile range (IQR) 126 to 196). Mean weight loss per IGB was 8.9 kg (95% CI 7.4 to 10.4), range 32.2 kg weight loss to 11.6 kg weight gain. 62 (36.1%) IGBs were removed prematurely and 48 (27.9%) patients required emergency treatment. Of these, 47 (97.9%) had nausea or vomiting, 20 (41.7%) abdominal pain, 5 (10.4%) haematemesis or melaena, and 13 (27.1%) hypokalaemia. Median time to emergency treatment was 7 days from IGB insertion (IQR 2 to 23), and median length of stay was 2 days for emergency admissions (IQR 1 to 4). 31 (64.6%) underwent inpatient IGB removal.
On average, for every 1 kg increase in baseline weight, weight loss increased by 0.11 kg (95% CI 0.03 to 0.18), and there was a 2% reduction in the odds of premature removal (OR 0.98, 95% CI 0.97 to 1). Patients with previous experience of IGBs lost 6.6 kg less than those naive to IGBs (95% CI −9.5 to −3.71) and had a 64% increase in the odds of premature removal (OR 1.64, 95% CI 0.87 to 3.09). Age and sex did not affect any outcomes, and no studied factor affected emergency treatment.
Conclusion The IGB offers an interventional weight loss alternative to patients who do not want, or who are not fit for, bariatric surgery. The more overweight individuals have better outcomes. Further research is required to identify factors associated with adverse events following IGB insertion.
. Yorke E, Switzer NJ, Reso A, et al. Intragastric Balloon for Management of Severe Obesity: a Systematic Review. Obesity Surgery. 2016
Disclosure of Interest None Declared
- bariatric endoscopy
- intragastric balloon
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