Comparative Efficacy and Long-Term Outcomes of Intragastric Balloons for Obesity: A Systematic Review and Meta-Analysis.

Intragastric balloons (IGBs) are a prominent intervention for obesity management, yet uncertainties persist regarding their comparative effectiveness and long-term durability due to variability in device types and follow-up durations. This systematic review and meta-analysis evaluated the short- and long-term weight loss efficacy of IGBs, stratifying by device type (BioEnterics Intragastric Balloon (BIB) (Allergan, Inc., Irvine, CA) vs. Heliosphere® (Helioscopie, Vienne, France), study design, and geographic region. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines, we identified 27 studies (5,842 patients) from PubMed, Embase, Cochrane Library, and Web of Science (2000-2023), reporting weight/BMI outcomes pre- and post-IGB removal with ≥6 months of follow-up. Data extraction and random-effects meta-analyses were conducted independently by two reviewers, with primary outcomes being mean weight loss and BMI reduction at device removal, and secondary outcomes assessing weight regain at six, 12, 24, and ≥60 months post-removal. Pooled short-term results demonstrated significant efficacy at balloon removal: mean weight loss of 14.9 kg (95% CI 12.7-17.0; I² = 44.05%) and BMI reduction of 5.31 kg/m² (95% CI 4.22-6.40; I² = 0%), with BIB devices outperforming Heliosphere (2.1 kg greater weight loss, p = 0.03; 0.8 kg/m² greater BMI reduction, p = 0.04). Long-term outcomes revealed durable weight maintenance over six to 60 months (mean 8.01 kg, 95% CI 4.93-11.09; I² = 60.55%; BMI reduction: 4.96 kg/m², 95% CI 3.29-6.62; I² = 0%), with effects persisting at five years (weight: 7.26 kg; BMI: 1.5 kg/m²). Subgroup analyses highlighted significant regional disparities - Middle Eastern cohorts achieved 8.6% greater excess weight loss (p = 0.02) and 1.2 kg/m² greater BMI reduction (p = 0.01) versus European cohorts - while prospective studies reported higher weight loss than retrospective analyses (13.1 vs. 11.8 kg; p = 0.04). These findings confirm the clinical utility of IGBs, particularly BIB devices, for achieving sustained weight loss. They underscore the critical importance of adjunct dietary interventions and multidisciplinary care frameworks in optimizing outcomes. The results provide actionable insights for evidence-based device selection and post-procedural protocols in obesity management.