Intragastric balloons for obesity: critical review of device design, efficacy, tolerability and unmet clinical needs.

INTRODUCTION: Sustaining a healthy weight is a great challenge and obesity has become a pandemic with associated risk of co-morbidities, hence a major concern for public health bodies worldwide. Surgical interventions, such as bariatric surgery, have shown a great promise for many where pharmacological and lifestyle interventions failed to work. However, challenges and limitations associated with bariatric surgery has pushed the demand for less invasive, reversible (anatomically) interventions, such as intragastric balloons (IGBs).

AREAS COVERED: This review critically appraises IGBs used in the past, present and those in clinical trials, discussing the device designs, limitations, placement and removal techniques, patient eligibility, efficacy and safety issues.

EXPERT OPINION: Several intragastric balloons were developed over the years that brought excitement to patients and healthcare professionals alike. Albeit good efficacy, there had been several safety issues reported with IGBs such as spontaneous deflation (premature balloon rupture), intestinal occlusion, gut perforation, and mucosal ulcerations. This led to evolution of IGBs design; device material, filling mechanism and fluid type, inflation volume, and further innovations to ease ingestion and removal of device. There are some IGB devices under development aimed to swallow like a conventional pill and excrete naturally through defecation following biodegradation in gut lumen, however, how successful they will be in clinical practice in terms of their efficacy and tolerability remains to be seen in the future.