Major considerations in the use of bariatric endoscopic therapy (intragastric balloon) and nutrological therapy in successful weight loss in patients with obesity: a systematic review

Introduction: Obesity is a chronic and multifactorial disease that affects more than 2.2 billion people worldwide. Treatment options for obesity have expanded significantly and include lifestyle changes, pharmacotherapy, endoscopic bariatric therapies, and bariatric surgery. Objective: It was to carry out a systematic review to present the main considerations regarding the use of the intragastric balloon as bariatric endoscopic therapy and nutritional therapy in an attempt to achieve successful weight loss in patients with obesity. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from June to August 2023 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 129 articles were found. A total of 34 articles were evaluated in full and 24 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 26 studies with a high risk of bias and 12 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X2 =74.7% >50%. In the challenges against super obesity and comorbidities, the use of endoscopic devices has been reported for many years, with the majority of positive results for patients. These devices are gaining increasing acceptance, and the Food and Drug Administration (FDA) has approved three endoscopic devices for use. Patients should be carefully assessed nutritionally and medication-wise and advised on the most appropriate route. To promote long-term adherence, any dietary intervention must take into account patients' dietary preferences, cultural context, and food availability. Ideally, use a combination of Mediterranean and high-protein diets to promote weight loss based on the patient's preference.