THE PROS AND CONS OF GASTRIC BALLOONS
In a new ASMBS Webinar Series, the Communications Committee invited two surgeons to debate the pros and cons of gastric balloons for weight loss. Committee Chair, Daniel Herron, MD, FACS, chief of bariatric surgery at The Mount Sinai Medical Center and Co-Chair, Richard Peterson, MD, director at U T Weight Loss and the UT Medicine Center for Bariatric and Metabolic Surgery moderated the live event, which was viewed by more than 100 members.
Manoel Galvao Neto, MD, director of innovation at the International Bariatric Club in São Paulo, Brazil presented in the affirmative, while Alfons Pomp, MD, FACS, FRCSC, FASMBS, chief of gastrointestinal, metabolic and bariatric surgery at New York/Presbyterian Hospital in New York City took the opposing view.
Dr. Galvao Neto said gastric balloons are intended to effectively fill the gap between medical treatment of obesity and bariatric procedures, and should not be viewed as taking the place of surgery. He emphasized that the devices are designed to be a temporary, ambulatory treatment, offering patients for whom surgery is not an option or who are not interested, an alternative.
In addition to the “traditional” uses, such as a bridge procedure for patients with super obesity (BMI>50), Dr. Galvao Neto offered cases in which gastric balloons have been successfully used for “alternative indications.” These include use in patients with lower BMIs with hard to control co-morbidities such as diabetes or hypertension, improving fertility in women through excess weight loss, and women who experience post-pregnancy obesity. He added that given the device’s similar safety profile to liposuction, gastric balloons might have a role in “aesthetics.”
In a friendly rebuttal, Dr. Pomp began by commenting that ultimately he planned to “win this one” over Dr. Galvao Neto by explaining why “gastric balloons are just a lot of air.”
According Dr. Pomp, excluding industry supported data, editorial columns and case studies, there is a lack of published literature on the use of gastric balloons. He continues that given the thousands of gastric balloon procedures that have been done since 1997, only seven articles demonstrated results from 3 to 6 months and 11 articles had results from 6 to 12 months. “If this was really worth something, than you would have more articles than this,”
Dr. Pomp said.
In addition, Dr. Pomp cites that average weight loss among gastric balloon patients is 12-15 kilos, similar to results seen with patients taking weight loss medications, which do not require what could be considered a “relatively invasive” procedure that he says has been shown to have complications including bowel and esophagus perforation, pancreatitis and cardiac ischemia. He adds that in patients who have undergone gastric balloon procedures, their weight at a 5 year-follow-up has been shown to be relatively unchanged from baseline BMI, in contrast to patients who had bariatric surgery and show sustained levels of excess weight loss up to 20 years.
The views expressed during the debate are those of the participants and do not necessarily reflect the views of the ASMBS.
A recording of the debate, as well as debate results, will soon be available on the ASMBS website. Also, watch your email for information about the next webinar. https://asmbs.org/asmbs-webinar-series