Personalization of Endoscopic Bariatric and Metabolic Therapies Based on Physiology: a Prospective Feasibility Study with a Single Fluid-Filled Intragastric Balloon

Gontrand Lopez-Nava, Veeravich Jaruvongvanich, Andrew C. Storm, Daniel B. Maselli, Inmaculada Bautista-Castaño, Eric J. Vargas, Reem Matar, Andres Acosta, Barham K Abu Dayyeh

Research output: Contribution to journalArticle

Abstract

Background: The intragastric balloon (IGB) is commonly used for weight loss. Identifying patients who are most likely to tolerate and benefit from IGB therapy will optimize outcomes. Our aims were to prospectively utilize a gastric emptying study to predict intolerance and treatment response with a single fluid-filled IGB and to develop a physiologic prediction model with a treatment algorithm. Materials and Methods: A total of 32 patients had a gastric emptying study before and 2–3 months after placement of an IGB. Multiple logistic regression analyses were performed to calculate likelihood ratios and to develop a physiologic prediction model. Results: Patients in the higher gastric retention quartile at baseline had a 6.2-time higher likelihood ratio for early balloon removal secondary to intolerance (p = 0.013). Utilizing baseline gastric emptying to predict intolerance to the IGB may have prevented 75% of early removal cases. Decreased gastric emptying at 3 months after balloon placement was significantly correlated with percent total body weight loss (%TWBL) at 6 and 12 months (p = 0.01 and p = 0.014, respectively). At 6 months after IGB, patients with no change in their gastric emptying at 3 months lost significantly less weight compared with those with increased gastric retention (median %TBWL = 9.0% [4.5–14.7] versus 17.3% [12.2–24.4], p = 0.016). Conclusion: Utilizing gastric emptying as a physiologic predictor of intolerance and response to the single fluid-filled IGB can improve outcomes. This pilot feasibility trial ushers in the era of personalized endoscopic bariatric therapies to maximize patients’ tolerance, cost-effectiveness, and meaningful weight loss.

Original languageEnglish (US)
Pages (from-to)3347-3353
Number of pages7
JournalObesity Surgery
Volume30
Issue number9
DOIs
StatePublished - Sep 1 2020

Keywords

  • Gastric emptying
  • Intolerance
  • Intragastric balloon
  • Obesity
  • Personalized medicine
  • Weight loss

ASJC Scopus subject areas

  • Surgery
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

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    Lopez-Nava, G., Jaruvongvanich, V., Storm, A. C., Maselli, D. B., Bautista-Castaño, I., Vargas, E. J., Matar, R., Acosta, A., & Abu Dayyeh, B. K. (2020). Personalization of Endoscopic Bariatric and Metabolic Therapies Based on Physiology: a Prospective Feasibility Study with a Single Fluid-Filled Intragastric Balloon. Obesity Surgery, 30(9), 3347-3353. https://doi.org/10.1007/s11695-020-04581-6