Intragastric Balloons in the Management of Obesity
Treatment
1. In individuals with obesity seeking a weight-loss intervention who have failed a trial of conventional weight-loss strategies, AGA suggests the use of IGB therapy with lifestyle modification over lifestyle modification alone a,b.
( Moderate , Conditional (weak) )a Trials in the United States were limited to a BMI range between 30–40 kg/m2. Individuals with BMI values outside this range were sometimes included in international trials.
b Fluid filled balloons may be associated with more weight loss, lower tolerability, and less favorable safety profile, than air fluid balloons. A shared decision making is suggested for determining device choice.
2. In individuals with obesity undergoing IGB therapy, AGA recommends moderate- to high-intensity concomitant lifestyle modification interventions to maintain and augment weight loss.
( Moderate , Strong )4. In individuals undergoing IGB therapy, AGA suggests using the intraoperative anesthetic regimens associated with the lowest incidence of nausea along with perioperative antiemetics. AGA suggests a scheduled antiemetic regimen for 2 weeks after IGB placementc.
( Low , Conditional (weak) )Implementation remarks:
c Evidence is insufficient to recommend a specific antiemetic regimen. The choice of regimen is based on institutional policy, clinical context and availability
Recommendation Grading
Overview
Title
Intragastric Balloons in the Management of Obesity
Authoring Organization
American Gastroenterological Association
Publication Month/Year
March 31, 2021
Last Updated Month/Year
October 3, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
Obesity is a global pandemic, affecting about 40% of adults in the United States. There is a vast area of unmet need with respect to weight-loss interventions, as only 1.1% of eligible patients with obesity are receiving primary bariatric surgery. Endoscopic bariatric therapies have evolved as an attractive tool for weight loss; however, <5% of patients with obesity seeking a weight-loss therapy are aware of endoscopic weight-loss options. Intragastric balloons (IGBs) launched nearly 4 decades ago have recently gained more popularity with multiple new devices introduced into the US market. Although IGBs are a plausible option for patients seeking weight loss, it is essential for providers, patients, and health care teams to understand how IGBs can augment the effect of lifestyle modifications with respect to important patient outcome measures, such as weight loss, improving metabolic parameters, and minimizing comorbid medical conditions. At the same time, it is also important for providers and patients to be aware of the adverse events and tolerability associated with IGBs, given that the devices have evolved over the years and newer models are available in the US market. This guideline can assist both patients and providers in determining whether IGB is a weight-loss option that should be considered and/or pursued in patients with obesity.
Target Patient Population
Patients with obesity
Inclusion Criteria
Male, Female, Adult
Health Care Settings
Ambulatory, Hospital, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management
Diseases/Conditions (MeSH)
D009765 - Obesity
Keywords
obesity, Clinical Practice Guidelines, Intragastric Balloons, Endoscopic bariatric therapies
Source Citation
Thiruvengadam M, Day LW, Teigen LM, et al. AGA Clinical Practice Guidelines on Intragastric Balloons in the Management of Obesity. A Report From the American Gastroenterological Association Institute. Gastroenterology. 2021;160:1799–1808.