Review of endoscopic devices for weight reduction: old and new balloons and implantable prostheses

The worldwide epidemic of obesity is forecast to worsen with a concomitant increase in the burden of co-morbid conditions. Bariatric surgery has some disadvantages, and intragastric balloons (IGBs) represent a generally safe, reversible and less invasive approach to weight reduction, based on occupying gastric space to enhance the sensation of satiety. A literature review found that the majority of the published data on IGBs relates to the Bioenterics intragastric balloon (BIB). The evidence for the efficacy of the BIB as a primary means of weight loss is still unconvincing, but it appears to have value in subgroups of patients, for example to improve quality of life, ameliorate co-morbidities, or provide a bridge to surgery. Regarding other IGBs, even if there are promising weight loss results, more evidence and development is generally needed: it is difficult to evaluate the Heliosphere Bag because of the limited clinical experience; the Adjustable Totally Implantable Intragastric Prosthesis (ATIIP)-Endogast may have problems associated with the percutaneous endoscopic gastrotomy (PEG)-type insertion method; the Semistationary Antral Balloon (SAB) may require technical improvements; and the Silimed Gastric Balloon (SGB) warrants further investigation. Another implantable device, the endoscopic duodenal-jejunal sleeve is based on a different concept, that of mimicking bariatric surgery; it effectively bypasses the duodenum and jejunum, and shows promising results. Other endoscopically implantable devices, such as the Butterfly and tubular membranes are at an experimental stage.