Simona Masia

Introduction Fluid-filled intragastric balloon (FF-IGB) placement is an endoscopic bariatric procedure that effectively achieves short-term weight loss in patients affected by obesity. Comparative data among different balloon volumes are lacking. This study aimed to assess efficacy and safety of FF-IGB at different volumes. Methods A randomized single-center analysis over 156 patients undergoing FF-IGB at a volume of 500 ml, 600 ml, or 700 ml with 6-month follow-up was conducted. Outcomes included postprocedural adverse events (AEs), early device removal for intolerance, evaluation of percentage of total weight loss (TWL%), excess weight loss (EWL%), and quality of life (QoL) at 6-month follow-up. Results The mean age of our cohort was 46.2 years, and 69.2% were female. The mean BMI was 41.9 kg/m². Pain was the main adverse event being detected in 78.3% patients, followed by nausea (76.8%), and vomiting (50.7%). No serious AEs were reported. Ten patients required early balloon removal for epigastric pain, nausea, and vomiting. The FF-IGB volume was not associated with nausea (p = 0.657), vomiting (p = 0.487), pain (p = 0.182), or early removal (p = 0.988). Decrease in body mass index (BMI) after 6 months was significant (mean BMI 35.24 kg/m², SD 7.17, p < 0.001). Mean TWL% after 6 months was 14.16. No significant difference between the FF-IGB volume and TWL% (p = 0.412) was detected. At 6 months follow-up, the mean EWL% was 30.8 ± 23.3 with no differences among the three groups of different FF-IGB volumes (p = 0.733). A significant improvement of QoL was detected at 6 months unrelated to the FF-IGB volume (p = 0.849). Conclusion FF-IGB placement resulted in significant weight loss over a 6-month period. No differences in TWL%, EWL%, rate of AEs, percentage of early device removal, and QoL were detected among the three groups with a different IGB volume. A 500 ml filling volume could be “the magic number” as no significant benefits are achieved with a greater volume. Key Points • Fluid-filled intragastric balloon (FF-IGB) placement effectively achieves short-term weight loss in patients affected by obesity, but comparative data among different balloon volumes are lacking. • Weight-loss outcomes, adverse-event rates, and quality-of-life gains were identical across 500 ml, 600 ml, and 700 ml balloon volumes. • A 500 ml filling volume for fluid-filled intragastric balloons could be “the magic number,” as larger volumes confer no additional benefit.

Background Bariatric surgery (BS) is an effective intervention for severe obesity, but some patients may experience sub-optimal weight loss. This study investigates the role of preoperative body composition parameters, measured via bioelectrical impedance analysis (BIA), in predicting postoperative weight loss outcomes. Methods A retrospective analysis was conducted on 102 patients who underwent sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or one-anastomosis gastric bypass (OAGB) between January 2020 and April 2023. Preoperative body composition metrics, including fat mass (FM), fat-free mass (FFM), body cell mass (BCM), and phase angle (PhA), were correlated with percentages of excess weight loss (%EWL) and total weight loss (%TWL) at 12 months post-surgery. Results The study found that patients with higher preoperative BCM and PhA showed significantly better weight loss outcomes. Specifically, patients with optimal weight loss had a mean BCM of 35.2 ± 3.5 kg and a PhA of 6.1 ± 0.5, whereas those with sub-optimal outcomes had a mean BCM of 29.8 ± 4.2 kg and a PhA of 4.9 ± 0.6 (p < 0.01 for both). Additionally, higher FM was associated with lower %EWL (r = − 0.40, p < 0.01). Multivariable logistic regression analysis identified BCM (OR 2.1, 95% CI 1.3–3.4) and %FM (OR 0.7, 95% CI 0.5–0.9) as independent predictors of successful weight loss. Conclusions Preoperative BIA parameters, particularly BCM and %FM, are significantly associated with weight loss outcomes in BS patients. These findings suggest a potential role in guiding pre-surgical patient assessment and tailored care, while acknowledging that this relationship is correlational and not necessarily causal.