Comparing Different Gastric Balloons

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The history of using gastric balloons for weight loss traces back to the 1950s, with one of the earliest approved models called the Garren-Edwards Bubble. It was a cylindrical balloon filled with liquid, that took up space in the stomach, prompting a reduction in food intake and, consequently, weight loss. This simple concept has since been copied by numerous companies that have introduced various versions of the gastric balloon.

Although they all fall under the umbrella of “intragastric balloons”, there are some interesting differences that set them apart. Let’s review six different types of gastric balloons.

Type of Gastric balloons

Orbera balloon

The Orbera balloon is probably the most commonly used gastric balloon in North America. It’s actually the first gastric balloon to be approved in the U.S. As such, they’ve been used the longest, and have the most research backing their use. Nearly all the patients I support for weight loss have this particular balloon, making it the one I’m most accustomed to.

In its basic form, it’s a single silicone balloon. The process involves inserting the deflated balloon through your mouth into the stomach and then filling it up with around 700 ml of liquid. That’s about the size of a grapefruit.

Removal follows a similar route – draining the liquid and then pulling it out through the mouth. Both procedures require sedation. Typically, the Orbera balloon stays in your stomach for six months, but there’s a variation, the “Orbera365,” that can stay put for up to a year.

One big plus with Orbera is its widespread use. Given its long history of use, many doctors are experienced with the insertion process, reducing the risk of serious mishaps or nasty side effects compared to less common options. Plus, it’s proven to be quite effective, as numerous studies over its extensive history have shown.

ReShape Duo

The ReShape Duo balloons are two gastric balloons linked together. They slide the deflated setup into your stomach through your mouth and then fill both balloons with liquid. The maximum inflation is 450 ml for each of the balloons, totaling 900 ml. You’ll be sedated for both insertion and removal, and it’s designed to stay in your stomach for about 6 months.

The dual balloon design aims to improve the fit of the stomach, supposedly enhancing appetite suppression. However, there’s no evidence suggesting that it’s more effective for weight loss than the Orbera. While the double balloon setup lowers the risk of one balloon bursting and causing a blockage in the intestines, the trade-off is a bulkier balloon system, and subsequently more complex insertion process compared to the simpler Orbera balloon.

Though FDA approved, the ReShape Duo isn’t as widely used, and it’s actually been phased out recently, making it potentially harder to come by these days.

Spatz3 balloon

The Spatz3 balloon is able to adjust its volume while in the stomach. The balloon is attached to a short tube which is left in the stomach. This nifty setup allows the surgeon to go back in whenever needed, using the tube to tweak the balloon’s volume. Liquid can be added or removed based on how well you’re handling it and your weight loss journey. It maxes out at 900 ml for those who can handle it.

You’ll also need to be sedated for both insertion and removal procedures, as well as any adjustment procedures. It can stay in the stomach for up to 12 months.

However, there’s a catch. This balloon system is a bit heftier and more complex, lacking the smooth, round simplicity of the Orbera. Also, it’s a relatively recent FDA approval, so not many doctors have honed their skills with this system. As a result, the insertion, removal, and adjustment procedures tend to take a bit longer and are a tad more difficult to do.

Heliosphere balloon

The Heliosphere balloon, also known as the Heliosphere bag, is a gastric balloon that’s filled with gas. The system can hold up to 1 liter of gas, however, like other gas-filled balloons, the actual volume of the balloon is less because air compresses more than liquid. So, 1 liter of air in the Heliosphere bag compresses down to around 700 ml in the stomach.

Are there benefits of using gas? Well it’s supposedly easier on the stomach, aiming to minimize post-insertion discomfort like pain, nausea, and vomiting. That’s because it’s lighter and shouldn’t irritate and bang around the stomach as much.

However, inflating an air-filled balloon in the stomach is trickier compared to a liquid-filled balloon, and many surgeons find that it’s harder to manipulate when positioning it. So the insertion process tends to stretch out longer. Plus, air-filled balloons are more prone to leakage, increasing the risk of deflation and other related issues.

Another problem is that having gas in the balloon means you can’t engage in activities like scuba diving, high-altitude mountain climbing, or travel in unpressurized airplane cabins, as it could blow up the balloon if you’re not careful. Due to these complexities, gastric balloons filled with air are not commonly used, and the Heliosphere balloon is not even FDA approved for use.

Obalon balloon

The Obalon balloon is another gas filled balloon which is delivered in a unique way. It can be swallowed as a pill, and doesn’t require sedation to insert it. The pill is connected to a thin tube and filled with gas once in the stomach.

However, to remove the balloon, the surgeon needs to fish it back out, so sedation is still required for removal. These balloons are smaller, holding only 250 ml of gas each, but you can use up to three at a time for added volume. All the balloons are removed by six months after the first balloon’s insertion.

With a smaller starting balloon and no sedation required during insertion, it’s generally better tolerated upfront. And more balloons can be added later as the patient progresses in their weight loss. However, like other gas-filled balloons, it’s a bit more compressible, making it less effective than the liquid balloons when it comes to appetite suppression and weight loss. The Obalon balloon is FDA approved, although not commonly used.

Allurion balloon

The Allurion balloon takes the convenience of the Obalon balloon up a notch. It’s not just a pill you swallow, but also designed to break down over 4 months and deflate on its own. Once deflated, the remaining thin material naturally travels through your digestive system and gets passed out the usual way.

The biggest benefit of this all is the convenience factor. No need for sedation during both insertion and removal. Just swallow the pill, let it do its thing for 4 months, and out it goes. It’s the easiest and simplest balloon for patients, cutting down on medical personnel, side effects, and often cost.

Now, here’s the catch. Since the balloon needs to exit on its own, it’s a bit smaller, and contains 550 ml of liquid. Plus, it’s made of a thinner material, which might not be as potent as the sturdier gastric balloons that require sedated removal. And, because the passing process isn’t foolproof, there have been rare instances of the balloon getting stuck and causing blockages in the intestines, requiring surgical intervention.

Allurion is approved in Canada but is still awaiting approval in the US. It’s actually gained a bit of popularity recently for its convenient, user-friendly approach.

Which balloon is most effective?

So which is the most effective for weight loss? There isn’t a straightforward answer, mainly because there aren’t direct comparisons between them. Using the different balloon sizes as a yardstick isn’t very helpful either, as the actual final volume of the balloon depends on the patient’s stomach size and the surgeon’s comfort level during installation.

From observing patient experiences and looking into the research, it seems that thinner-walled balloons like the Allurion may not be as effective as their thicker-walled counterparts such as Orbera, ReShape Duo, or Spatz3. Also I haven’t seen any convincing evidence to suggest that there is much of a difference between any of the thick walled balloons.

Thinner-walled balloons tend to lose their shape easily, get manipulated and compressed by the stomach, and deflate quicker over time. Gas-filled balloons like Heliosphere or Obalon might also be less effective, based on the research.

All that being said, Orbera is the most extensively studied balloon, typically delivering a weight loss ranging from 5-15% body weight while in use. Despite some marketing claims of greater weight loss with some of the newer balloons, the studies supporting such assertions are often small. So I’m not convinced, and I’d expect a pretty similar real-world efficacy with those other balloons as well.

Learn more about

• Gastric Balloon Diet Plan
• The Allurion gastric balloon
• Medical devices for weight loss
• Gastric balloon for weight loss
• Other weight loss procedures

See also

• 
  Comparing Different Gastric Balloons
  Many types of gastric balloons exist, from swallowable to adjustable, although the standard Orbera balloon remains the most commonly used.
• 
  Gastric Balloon Diet Plan
  Once you have a gastric balloon, properly transitioning from liquids on day 1 to 3, to solids by day 14, is key to success on your balloon.
• 
  The Allurion gastric balloon
  The Allurion is a swallowable gastric balloon that naturally passes into the stools itself. However, it is smaller than the Orbera balloon.
• 
  Medical Devices for Weight Loss
  Medical devices like lap-bands, gastric balloons, or AspireAssist often face issues that make them less ideal for weight loss than they seem.
• 
  Gastric Sleeve vs Gastric Bypass
  Gastric bypasses more drastically alter your stomach, and are more effective than the sleeve. Both are serious weight loss surgeries.