Intragastric Balloons in the Management of Obesity

Publication Date: March 31, 2021
Last Updated: August 27, 2024

Treatment

1. In individuals with obesity seeking a weight-loss intervention who have failed a trial of conventional weight-loss strategies, AGA suggests the use of IGB therapy with lifestyle modification over lifestyle modification alone a,b.

( Moderate , Conditional (weak) )
Implementation remarks:
a Trials in the United States were limited to a BMI range between 30–40 kg/m2. Individuals with BMI values outside this range were sometimes included in international trials.
b Fluid filled balloons may be associated with more weight loss, lower tolerability, and less favorable safety profile, than air fluid balloons. A shared decision making is suggested for determining device choice.
612

2. In individuals with obesity undergoing IGB therapy, AGA recommends moderate- to high-intensity concomitant lifestyle modification interventions to maintain and augment weight loss.

( Moderate , Strong )
612
3. In individuals undergoing IGB therapy, AGA recommends prophylaxis with PPIs. ( Moderate , Strong )
612

4. In individuals undergoing IGB therapy, AGA suggests using the intraoperative anesthetic regimens associated with the lowest incidence of nausea along with perioperative antiemetics. AGA suggests a scheduled antiemetic regimen for 2 weeks after IGB placementc.

( Low , Conditional (weak) )

Implementation remarks:
c Evidence is insufficient to recommend a specific antiemetic regimen. The choice of regimen is based on institutional policy, clinical context and availability

612
5. In individuals undergoing IGB therapy, AGA suggests against perioperative laboratory screening for nutritional deficiencies. ( Low , Conditional (weak) )
612
6. AGA suggests daily supplementation with 1–2 adult dose multivitamins after IGB placement. ( Very Low , Conditional (weak) )
612
7. After IGB removal, AGA suggests subsequent weight-loss or maintenance interventions that include dietary interventions, pharmacotherapy, repeat IGB, or bariatric surgery. The choice of weight-loss or maintenance method after IGB is determined based on patient’s context and comorbidities following a shared decision-making approach. ( Low , Conditional (weak) )
612

Recommendation Grading

Overview

Title

Intragastric Balloons in the Management of Obesity

Authoring Organization

American Gastroenterological Association

Publication Month/Year

March 31, 2021

Last Updated Month/Year

August 28, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Male, Female, Adult

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D009765 - Obesity

Keywords

obesity, Clinical Practice Guidelines, Intragastric Balloons, Endoscopic bariatric therapies

Source Citation

Thiruvengadam M, Day LW, Teigen LM, et al. AGA Clinical Practice Guidelines on Intragastric Balloons in the Management of Obesity. A Report From the American Gastroenterological Association Institute. Gastroenterology. 2021;160:1799–1808.

Supplemental Methodology Resources

Technical Review, Data Supplement