“The Elipse Balloon, a swallowable gastric balloon for weight loss not requiring sedation, anesthesia or endoscopy: a pilot study with 12 month outcomes” a new article published in the current SOARD issue by Dr. Raftopoulos.Dr. Raftopoulos receives consulting fees from Allurion technologies. Allurion technologies, Natick, MA, USA is the developer company of Elipse Balloon. The study is a prospective, nonrandomized and observational analysis of 12 enrolled patients. Elipse Balloon is folded in a vegetarian capsule and attached to a thin catheter via a self-sealing valve. Patients swallow the capsule; an X-ray study confirms position in the stomach before filling the balloon with 550 ml of water. The catheter is disconnected from the balloon by pulling it out. A bio-absorbable film covers the valve and degrades slowly over a 4-month period. Once degraded, the valve is exposed and the balloon empties spontaneously. It is then expected to pass through the pylorus into the intestines and then naturally excreted. In this study, 3 patients vomited the balloon and the rest excreted it in stool with no complications. The authors recommend soft diet and antiemetic towards the end of the treatment to prevent balloon emesis.

As with previous balloon studies the authors find excellent weight loss comparable to other balloon devices on the market like Obalon, Orbera and Reshape. They caution us, however, on “substantial weight regain” if balloon patients “do not take advantage of balloon therapy and transition to a permanent healthier lifestyle”. The authors further add: “these new technologies should be embraced in the context of long-term exercise, diet and behavior modification protocol that will maximize long-term weight maintenance. A balance between practice growth potential by the introduction of these technologies and a commitment to long-term quality care and patient education must be struck to achieve this goal”.

Unfortunately, we continue to read the same wrong rhetoric about diet and exercise to maintain weight loss. Diet and exercise are ineffective in maintaining weight loss unless the underlying metabolic abnormality has been addressed. Gastric balloon, a purely restrictive procedure, unlike sleeve gastrectomy and gastric bypass surgery, does not alter metabolism. Therefore, balloon induced starvation over a 4-month period is unlikely to result in permanent weight loss despite adhering to a healthy lifestyle. This basic metabolic and weight loss concept has been clearly established. The working hypothesis for weight loss surgery is clear. We need to properly use this knowledge to develop new effective weight loss technology rather than ineffective but minimally invasive techniques that are only effective in misleading obese patients struggling to lose weight.