ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Int J Obes 2018; 42: 115-118

Intragastric balloons have now been used for more than 30 years in the treatment of extreme obesity. There are more than 30 studies published with almost 5,000 patients on the efficacy and safety of gastric balloons. However, due to several, sometimes severe side effects and the lack of convincing long-term outcomes, this treatment approach has been used less frequently in the last two decades. Since recent studies have shown that conservative treatment approaches are not successful in adolescents with extreme obesity, the use of intragastric balloons might be a therapeutic option in such cases in which the benefit-risk-evaluation for bariatric surgery is not convincingly positive. Especially for younger adolescents, the insertion of an intragastric balloon may help to improve weight and metabolic health during a maximal balloon application duration of 12 months. During this important time period, patients might either adapt their lifestyle in terms of food intake and physical activity behavior to a more healthy one being able to maintain the achieved weight loss (as has been shown for 2 of 10 patients of this study). In addition, while carrying the intragastric balloon, young patients might be prepared for a subsequent definitive bariatric procedure. There are some convincing arguments that in young adolescents with extreme obesity the intragastric balloon should be used prior to a definitive bariatric procedure.

This study reports sustained improvements in HBA1c and insulin AUC despite weight gain after removal of the intragastric balloon. However, since there was no control group, these maintained improvements might also be due to the fact that parameters of insulin sensitivity improve during late puberty and early adulthood, independent of weight changes in adolescents with obesity. Therefore, this result may not be directly related to the intragastric balloon.