Patients with obesity who have unsuccessfully tried conventional weight loss therapies may consider intragastric balloon (IGB) therapy to augment moderate- to high-intensity lifestyle modifications, according to new guidelines from the American Gastroenterological Association (AGA).
The guidelines were developed by the AGA Institute's Clinical Guidelines Committee and approved by the AGA Governing Board. An accompanying technical review includes a detailed synthesis of the evidence on which the recommendations were based. Both the guidelines and the evidence review were published April 1 by Gastroenterology.
Other recommendations include the following:
- Patients undergoing IGB therapy should be treated with proton-pump inhibitors to minimize GI bleeding risk, the guidelines recommended.
- Patients should be sedated for IGB placement with anesthetics associated with low nausea, and antinausea medication should be continued for two weeks, the guidelines suggested.
- The guidelines suggested against screening IGB patients for nutritional deficiencies but did suggest providing one to two multivitamins after IGB placement.
- After IGB removal, the guidelines suggested using dietary interventions, pharmacotherapy, repeat IGB, or bariatric surgery to maintain weight loss. Choice of maintenance strategy should be determined based on shared decision making, according to the guidelines.
Most of the guidelines' recommendations were conditional, and several were based on low- or very low-quality evidence. “The AGA acknowledges the limitations of the available evidence on this topic as well as the potential confounding based on IGB characteristics, RCT [randomized controlled trial] design, and geographic variations of included studies; however, a rigorous review of current data supports the efficacy and safety of IGBs for patients with obesity,” the guidelines' authors wrote.
Additional studies are needed to research long-term efficacy of IGB therapy versus the standard of care, predictors of device intolerance, and perioperative and post-IGB medication use, among other areas, the authors noted. They also stressed that most of the studies included in the technical review involved mainly White patients or did not report race or ethnicity. “Future research must concentrate on studying a more diverse patient population, identifying whether disparities exist in weight-loss treatment interventions offered to patients and assessing whether such disparities affect outcomes of weight-loss interventions,” the authors wrote.