Intragastric balloon for obesity

  • Review
  • Intervention

Authors


Abstract

Background

Obesity is one of the major public health problems of modern society. Intragastric balloon (IGB) treatment for obesity has been developed as a temporary aid. Its primary objective is the treatment of obese people, who have had unsatisfactory results in their clinical treatment for obesity, despite of being cared for by a multidisciplinary team, and super obese patients with a higher surgical risk. However, the effects of different IGB procedures compared with conventional treatments and with each other are uncertain.

Objectives

To assess the effects of intragastric balloon in people with obesity.

Search methods

Studies were obtained from computerised searches of MEDLINE, EMBASE, LILACS, The Cochrane Library and other electronic databases. Furthermore, reference lists of relevant articles and hand searches of selected journals were performed. Experts in the field were contacted.

Selection criteria

Randomised and quasi-randomised controlled trials fulfilling the inclusion criteria were used. Short term weight loss is common, so studies were included if they reported measurements after a minimum of four weeks follow-up.

Data collection and analysis

Data were extracted by one reviewer and checked independently by two reviewers. Two reviewers independently assessed the quality of trials.

Main results

Nine randomised controlled trials involving 395 patients were included. Six out of nine studies had a follow-up of less than one year, the longest study duration was 24 months. Only a third of the analysed studies revealed a low risk of bias. No information was available on quality of life, all-cause mortality and morbidity. Compared with conventional management, IGB did not show convincing evidence of a greater weight loss. On the other hand, complications of intragastric balloon placement occurred, however few of a serious nature. The relative risks for minor complications like gastric ulcers and erosions were significantly raised.

Authors' conclusions

Evidence from this review is limited for decision making, since there was large heterogeneity in IGB trials, regarding both methodological and clinical aspects. However, a co-adjuvant factor described by some authors in the loss and maintenance of weight has been the motivation and the encouragement to changing eating habits following a well-organized diet and a program of behavioural modification. The IGB alone and the technique of positioning appear to be safe. Despite the evidence for little additional benefit of the intragastric balloon in the loss of weight, its cost should be considered against a program of eating and behavioural modification.

摘要

背景

胃內氣球治療肥胖

肥胖是現今社會公共衛生的重大問題之一。胃內氣球(IGB)是治療肥胖的暫時輔助療法。此法乃針對肥胖者對多科之臨床團隊治療結果不滿意,和開刀風險較高的超胖者為其主要對象。然而胃內氣球不同作法之相互比較或與傳統治療比較,結果仍不確定。

目標

評估胃內氣球對肥胖者之影響

搜尋策略

研究由電腦搜尋MEDLINE, EMBASE, LILACS, The Cochrane Library以及其他電子資料庫獲得。此外,也搜查相關文章之參考文獻以及手動搜尋選定之期刊。並聯絡此範籌的專家。

選擇標準

採用符合納入標準的隨機和半隨機的控制試驗。短期減重常見,所以採用至少追蹤4週的研究。

資料收集與分析

一位審核者擷取數據,由兩位審核者分別獨立核對。兩位審核者分別獨立評估研究的品質。

主要結論

九個隨機控制試驗,有395個病人。九篇試驗裡面有六個追蹤不到一年;一個最長的試驗為24個月。只有三分之一的分析性試驗顯示出低風險的研究偏差。無生活品質、所有原因之死亡與罹病的資訊。比較減重的傳統治療,胃內氣球並無令人信服的證據顯示有更好的減重效果。此外,放置胃內氣球會有併發症,不過少有嚴重。輕併發症如胃潰瘍及胃糜爛的相對風險顯著升高

作者結論

以採用的方法學以及臨床特性而言,眾多胃內氣球的研究差別頗大,因此可以評論的證據有限,無法驟下結論。然而,有幾位作者描述到減重與維持體重之輔佐因子乃是激發與鼓勵病人改變吃的習慣,再給予有系統的飲食與行為修正的計畫。光胃內氣球與放置的技術看起來頗安全。胃內氣球對減重之額外好處不多,而且費用相較於飲食與行為修正的療程,需多一層考慮。

翻譯人

本摘要由慈濟醫院吳篤安翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

胃內氣球對極其肥胖者之減重其益處少但手術的併發症多。若飲食療法、增加運動與藥物療法之傳統治療無法讓肥胖者長期減重,其他方法如在專科中心施行的手術,對臨床治療無效的病態肥胖者是個可以考慮的選擇。矽製胃內氣球之研發乃短期性的幫助,尤其可讓曾接受多團隊之照護但治療不理想,和開刀風險較高的超胖者這些肥胖病人下降40%甚至更多的體重. 胃內氣球的放置與移除須經專家透過內視鏡的處理,氣球可自由在胃內浮動,氣球大小可在放置時調好。胃內氣球的技術減少胃的容積,可以提早有飽漲感。九個隨機有控制組的試驗,有395個病人。九篇實驗中有六個研究追蹤不到一年,期間最長的一個是24個月。這些研究的品質不一,也只有三分之一的分析性研究顯示出低風險的研究偏差。關於生活品質、所有原因的死亡與罹病率的資料付諸闕如。與傳統治療相比,沒有服人的證據顯示胃內氣球可以減重較多。輕併發症如胃潰瘍與胃糜爛之相對風險則顯著升高。

Plain language summary

Intragastric balloon for obesity

With the failure of conventional treatments like diet therapy, increased physical activity and drug therapy in producing long lasting weight loss in people with obesity, other approaches like surgery are performed in specialised centres, an option to be considered for patients with morbid obesity who do not respond to clinical treatment. The silicon intragastric balloon (IGB) has been developed as a temporary aid to especially achieve weight loss in obese people with 40% or more their optimal weight, who have had unsatisfactory results in their treatment for obesity, despite of being cared for by a multidisciplinary team and in super obese patients who often have a high risk for surgery. The placement and removal of the IGB is an interventionist endoscopic procedure and the balloon is designed to float freely inside the stomach, its size might be changed during the placement. The IGB technique reduces the volume of the stomach and leads to a premature feeling of satiety
Nine randomised controlled trials involving 395 patients were evaluated. Six out of nine studies had a follow-up of less than one year, the longest study duration was 24 months. The overall quality of trials was variable, only a third of the analysed studies showed a low risk of bias. No information was available on quality of life, all-cause mortality and morbidity. Compared with conventional management, IGB did not show convincing evidence of a greater weight loss. The relative risks for minor complications, for example gastric ulcers and erosions were significantly raised.

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