© FD-Communications Inc. Obesity Surgery, 16, 2006 897 Obesity Surgery, 16, 897-902 Background: Intragastric balloon placement in associ- ation with diet for weight reduction is steadily gaining popularity. However, long-term follow-up studies on the effect of this method in maintaining weight loss are lacking. This study evaluated the long-term out- come following balloon removal in morbidly obese patients who had selected this method for weight loss. Methods: 140 morbidly obese patients who refused bariatric surgery because of fear of complications and mortality, underwent intragastric balloon placement and were followed over a 6- to 30-month period (mean 18.3 months) after balloon extraction. The 34 males and 106 females, with median age 38 years (range 16- 62), median weight 122 kg (range 85-203), median BMI 42.3 kg/m 2 (range 35-61.3) and median excess weight (EW) 59 kg (range 29-132), received a Bioenterics Intragastric Balloon (BIB). Excess weight loss (EWL) ≥25% when the BIB was removed was considered a success. Weight fluctuations and any further interven- tional therapy requested by the patients after balloon removal were recorded. Results: 100 patients (71.4%) lost ≥25% of their EW on balloon extraction and were categorized as suc- cesses, while 40 patients (28.6%) did not achieve that weight loss and were categorized as failures of the method. During the follow-up period, 44 of the original- ly successful patients (31.4%) regained weight and were categorized as recurrences, while the remaining 56 patients (40%) maintained their EWL of ≥25% and were considered long-term successes. During follow- up, 45 patients (32.1%) requested and underwent bariatric surgery for their morbid obesity (21 Adjustable Gastric Band, 11 Laparoscopic Sleeve Gastrectomy, 13 Laparoscopic Gastric Bypass). Of these, 13 (32.5%) were from the group of 40 patients categorized as fail- ures on BIB removal, 28 (63.6%) were from the group of 44 patients whose obesity recurred, and 4 (7.1%) were from the 56 patents who although they maintained suc- cessful weight loss requested further weight reduction. Conclusions: The BIB served as a first step and a smooth introduction to bariatric surgery for morbidly obese patients who initially refused surgical interven- tion. The incidence of surgical intervention was dou- ble in patients who initially experienced the benefits of weight loss and then had obesity recurrence, com- pared with patients in whom the method failed. Indeed, a significant number of patients were assist- ed in their efforts to lose and maintain an acceptable weight loss over a 6- to 30-month follow-up period. Key words: Intragastric balloon, morbid obesity, bariatric surgery, weight loss Introduction Obesity is a common chronic disease that is affecting a gradually increasing portion of the population in industrialized countries. 1-3 The relationship between severe obesity and serious medical conditions such as hypertension, type 2 diabetes, hyperlipidemia, low back pain, etc. is well documented. 1,4-7 Conservative management with diet, exercise and medications as well as interventional treatment of this disease with The Intragastric Balloon – Smoothing the Path to Bariatric Surgery John Melissas, MD 1 ; John Mouzas, MD 2 ; Dimetrios Filis, MD 1 ; Markos Daskalakis, MD 1 ; Erminia Matrella, MD 2 ; John A. Papadakis, MD 3 ; Nikos Sevrisarianos, MD 4 ; Demetris Charalambides, MD 5 1 Bariatric Unit, Department of Surgical Oncology, 2 Departments of Gastroenterology and 3 Internal Medicine, Heraklion University Hospital, and 4 Department of Surgery, Creta Interclinic Hospital, Crete, and 5 Department of Surgery, Iasis Hospital, Paphos, Cyprus Reprint requests to: John Melissas MD, 15 Delaporta St., Heraklion, 71409, Crete, Greece. Fax: + 30 2810 542090; e-mail: melissas@med.uoc.gr OS16(7)Articles 6/27/06 10:59 AM Page 897