title: Is bariatric surgery necessary after intragastric balloon treatment?
abstract: BACKGROUND
  The use of the Bio-Enterics intra-gastric balloon (BIB) has been shown to be a safe and effective procedure for the temporary treatment of morbid obesity. We conducted a retrospective comparative analysis of the weight loss in patients that after BIB removal underwent bariatric surgery and those who did not wish surgery.
  
  
  METHODS
  From January 2000 to March 2004, 182 BIBs were positioned in 175 patients (104 F / 71 M; mean age 37.1+/-11.6 years, range 16-67; mean BMI 54.4 +/- 8.1 kg/m(2), range 39.8-79.5; mean %EW 160.8+/-32.9% range 89-264). Patients were excluded from this study who had emergency BIB removal for balloon rupture (n=2, 1.1%) and for psychological intolerance (n=7, 7.8%). All patients were scheduled for a bariatric operation, before BIB positioning. After BIB removal, a number of patients now declined surgery. Consequently, patients were allocated into 2 groups: Group A in whom BIB removal was followed by bariatric surgery (Lap-Band, laparoscopic gastric bypass, duodenal switch) (n=86); Group B patients who after BIB removal refused any surgical procedure (n=82). Both groups were followed for a minimum of 12 months. Results were reported as mean BMI and %EWL +/- SD. Statistical analysis was done by Student t-test or Fisher's exact test, with P<0.05 considered significant.
  
  
  RESULTS
  Mean BMI and mean %EWL in the 166 patients at time of removal were 47.3 +/- 8.1 kg/m(2) and 32.1+/-16.6%, respectively. At the same time, mean BMI was 47.6+/-6.9 and 48.1+/-6.5 kg/m(2) in group A and B (P=NS). At 12 months follow-up (100%), mean BMI was 35.1 kg/m(2) in Group A (BIB + surgery) and 51.7 kg/m(2) in Group B (BIB alone) (P<0.001).
  
  
  CONCLUSIONS
  After BIB removal, half (49.4%) of the patients scheduled for surgery refused a bariatric operation. These patients returned to their mean initial weight at 12 months follow-up. Therefore, bariatric surgery after BIB removal is highly recommended.
authors.affiliation: Federico II University of Naples, S. Giovanni Bosco Hospital, Unit of Endoscopic Surgery, Naples, Italy. luigiangrisani@chirurgiaobesita.it
authors.forename: Luigi
authors.initials: L
authors.lastname: Angrisani
authors.forename: Michele
authors.initials: M
authors.lastname: Lorenzo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Borrelli
authors.forename: Monica
authors.initials: M
authors.lastname: Giuffré
authors.forename: Carmine
authors.initials: C
authors.lastname: Fonderico
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Capece
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D015905:Gastric Balloon; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009767:Obesity, Morbid / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss