Intragastric occupying space devices

In 2016, 39% of adults were overweight, and about 13% of the world’s adult population were obese. Obesity represents a growing global public health despite the availability of diet and lifestyle counseling, pharmacologic therapy, and bariatric surgery. Endoscopic bariatric therapies (EBTs) encompass a wide range of devices requiring flexible endoscopy for placement or removal and procedures performed via flexible endoscopy for the treatment of obesity. Current primary EBTs can be classified as space-occupying or non-space-occupying devices (restrictive, bypass, or aspiration therapy). Intragastric balloons (IBG) act as space-occupying devices, reducing stomach capacity and inducing satiety by several mechanisms. To date, ORBERA® Intragastric Balloon System, RESHAPE DUO Intragastric Balloon, and OBALON Balloon System are approved by the US Food and Drug Administration (FDA) based on demonstrated safety and efficacy in randomized controlled trials (RCTs). Two other balloons are currently under FDA investigation: the Spatz Adjustable (Spatz Medical, Great Neck, NY) and the Elipse Balloon (Allurion, Natick, MA). TransPyloric Shuttle consists of two bulbs connected by a flexible silicone tether which facilitates partial gastric obstruction resulting in delayed gastric emptying and early satiety. Space-occupying devices represent a good therapeutic option in the treatment of morbid patients, above all if used as obesity prevention tool. Some of those devices need to demonstrate greater reliability in terms of safety.