Long-term multiple intragastric balloon treatment--a new strategy to treat morbid obese patients refusing surgery: prospective 6-year follow-up study.
BACKGROUND
Morbid obesity is an increasing health problem. Dietary intervention often fails in the medium to long term, and surgery is the gold standard. Intragastric balloon is a valuable treatment in the short-term, and multiple balloon treatment has been shown to be effective in the medium term. The aim of this study was to investigate the efficacy of multiple balloon treatment in the long-term (6 years) in terms of weight loss, influence on co-morbidities, and quality of life in patients refusing surgery.


METHODS
Eighty-three patients with body mass index (BMI)>40, good candidates for surgery but refusing it, were enrolled in a clinical treatment protocol involving multiple intragastric balloon placement. After removing the first balloon, a second balloon was placed when the patients had regained ≥ 50% of the weight loss achieved with previous balloon. Weight, co-morbidities parameters, and quality of life test were recorded during a follow-up of 72 months.


RESULTS
All patients experienced a second balloon placement; 22.2% had a third device placed and 1 patient had a fourth device placed. At 76 months follow-up, mean BMI was 37.6 kg/m(2) (P < .001); weight cycling periods were observed. Significant difference was recorded in the presence of co-morbidities at baseline (80% of the patients) and follow-up (30%) (P = .02). Quality of life test in the follow-up indicated better scores than those at baseline (P < . .001).


CONCLUSIONS
Despite the weight cycling, in patients refusing surgery, multiple intragastric balloon is the recommended treatment, allowing the patients to achieve a good weight loss, better control of co-morbidities, and better quality of life than at baseline.
Surgical Sciences Department, Umberto I General Hospital, Sapienza University, Rome, Italy. Electronic address: alfredo.genco@uniroma1.it.
Genco
G
Alfredo
"Paride Stefanini" Surgical Department, Umberto I General Hospital, Sapienza University, Rome, Italy.
Maselli
M
Roberta
Surgical Sciences Department, Umberto I General Hospital, Sapienza University, Rome, Italy.
Cipriano
C
Massimiliano
UOML ASL NA5, Torre Annunziata, Naples, Italy.
Lorenzo
L
Michele
Surgical Sciences Department, Umberto I General Hospital, Sapienza University, Rome, Italy.
Basso
B
Nicola
Surgical Sciences Department, Umberto I General Hospital, Sapienza University, Rome, Italy.
Redler
R
Adriano
D000328:Adult; D050110:Bariatric Surgery; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D015905:Gastric Balloon; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000628:therapy*; D011446:Prospective Studies; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome; D016312:Treatment Refusal; D015431:Weight Loss
BIB; Co-morbidities; Intragastric balloon; Multiple treatment; Quality of life; Weight cycling