Complications of the Intragastric Balloon

Intragastric balloons (IGB) have been used in the treatment of obesity for over 30 years. The first notable IGB device (the Garren Edwards Gastric Bubble) was withdrawn from the market due to patients’ poor weight loss and a high rate of complications. Several subsequent devices have been designed to address these shortcomings, but high-quality data are needed to compare complication rates among devices. Mortality across all IGB variants is extremely low compared to other bariatric procedures. Complications are mainly associated with visceral injury related to device insertion and retrieval, and with the presence or migration of an in-situ device, such as gastric ulceration and perforation, intolerance, gastrointestinal obstruction, and, rarely, acute pancreatitis. The incidence of postoperative venous thromboembolism (VTE) has not been extensively investigated, and it is not clear whether VTE is device-related or is due to increased VTE risk in bariatric patients.

Cholecystokinin and satiety: effect of hypothalamic obesity and gastric bubble insertion

Cholecystokinin (CCK) is a gut peptide whose proposed effect on satiety is thought to be related to gastric volume and to be signaled through vagal afferent fibers to the medial hypothalamus. To test these hypotheses we infused CCK C-terminal octapeptide (CCK-8) or saline in a random double-blind fashion in three groups of subjects: 17 obese subjects, 6 of whom subsequently received a gastric bubble, and 5 obese subjects whose obesity was due to hypothalamic injury. The number of sandwich canapes eaten after saline or CCK-8 infusion was recorded during three consecutive 10-min eating periods. Each subject served as his/her own control. The prior infusion of CCK-8 significantly decreased the consumption of sandwich canapes in the first eating period in both the control obese subjects and the subjects with obesity due to hypothalamic injury. Insertion of a gastric bubble did not enhance the satiety effect of CCK-8. These studies support the hypothesis that CCK produces satiety in a time-dependent manner that is not enhanced after the insertion of a gastric bubble but is operative in obese subjects with hypothalamic injury.