Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. May 16, 2021; 13(5): 115-124
Published online May 16, 2021. doi: 10.4253/wjge.v13.i5.115
Impact of intragastric balloon on blood pressure reduction: A retrospective study in Eastern North Carolina
Gbeminiyi Olanrewaju Samuel, Karissa Lambert, Elijah Asagbra, Glenn Harvin, Eric Ibegbu
Gbeminiyi Olanrewaju Samuel, Glenn Harvin, Eric Ibegbu, Division of Gastroenterology, East Carolina University, Greenville, NC 27834, United States
Karissa Lambert, Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27834, United States
Elijah Asagbra, Department of Health Services and Information Management, East Carolina University, College of Allied Health Sciences, Greenville, NC 27834, United States
Author contributions: Samuel GO and Lambert K collected and managed data, communicated with institutional review board, prepared study initiation activities, and helped with the writing of the manuscript; Asagbra E analyzed the data and helped with writing of the manuscript; Harvin G reviewed and helped with writing of the manuscript; Ibegbu E managed and provided data, reviewed and helped with writing of the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: This study was exempt from Institutional Review Board review after Institutional Review Board review (UMCIRB 19-001002).
Informed consent statement: A waiver of informed consent was obtained as the data are anonymized and the risk of the identification is low.
Conflict-of-interest statement: No relevant conflicts of interest exist for all authors.
Data sharing statement: Statistical codes, and dataset available from the corresponding author at
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Gbeminiyi Olanrewaju Samuel, MD, Academic Fellow, Division of Gastroenterology, East Carolina University, 2100 Stantonsburg Road, Greenville, NC 27834, United States.
Received: August 25, 2020
Peer-review started: August 25, 2020
First decision: December 11, 2020
Revised: December 26, 2020
Accepted: April 7, 2021
Article in press: April 7, 2021
Published online: May 16, 2021

Obesity has evolved into a global pandemic. The prevalence of obesity and hypertension in eastern North Carolina are comparable, if not higher, than the national prevalence. In the United States, an estimated 34% of adults have hypertension, the most modifiable risk factor for heart disease and stroke. Lifestyle and pharmacological interventions often do not provide sustained weight loss in obese patients. Bariatric surgery offers an effective weight reduction with short-and long-term health improvements; however, a higher body mass index is associated with higher surgical morbidity and mortality, longer hospitalization, and increasing rates of 30-day readmission due to co-morbidities. Intragastric balloon may bridge a critical gap in the treatment of obesity. The objective of this paper is to showcase the impact of endoscopic bariatric therapy on blood pressure reduction.


To investigate the impact of intragastric balloon on blood pressure reduction.


A retrospective chart review was conducted from January 1, 2016 to January 31, 2019 of consecutive adults who received intragastric balloon therapy (IGBT) in a gastroenterology private practice in Eastern North Carolina. The balloon was introduced into the stomach under endoscopic guidance, and while in the region of the gastric body, inflation with saline was performed at increments of 50 mL until target volume between 500 to 650 mL of saline was attained depending on the patient's gastric capacity. No procedural complications were noted during endoscopic placement and removal of the balloon. A cohort study design was used for data analysis. A total of 172 patients had the Orbera® intragastric balloon placed. Of the 172 patients who had IGBT at baseline, 11 patients (6.4%) requested early balloon removal due to foreign body sensation (n = 1), and/or intolerable gastrointestinal adverse events (n = 10). The reported gastrointestinal adverse events were nausea, vomiting, abdominal pain, and diarrhea. Eventually, 6-mo follow-up data were available for only 140 patients. As a result, only the 140 available at the 6-mo follow-up were included in the analysis. Univariate, bivariate, and multivariate statistical analyses were performed. Specifically, scatterplots were created to show the relationship between weight and blood pressure, and paired two-sample t-test was carried out to determine if there was a significant reduction in weight before and after the IGBT. Multiple regressions were also performed to examine the association between participants’ total body weight and blood pressure. The outcome variables for the multiple regression were systolic and diastolic blood pressure measured as continuous variables. This was followed by logistic regression analyses to determine the association between total body weight and hypertension at 6-mo post-implantation. The outcome variables for the logistic regression were systolic blood pressure–non-hypertensive (140 mmHg or less) or hypertensive (greater than 140 mmHg), and diastolic blood pressure–non-hypertensive (90 mmHg or less) or hypertensive (greater than 90 mmHg). All authors had access to the study data and reviewed and approved the final manuscript. All statistical analyses were done using STATA 14®.


The study included 15% males and 85% females. 50% of the patients were white and just over 22% were non-white, and about 27% declined to give their race. The average baseline patients’ weight prior to IGBT was 231.61 Lbs. (SD = 46.53 Lbs.). However, the average patients’ weight after IGBT at the 6-mo follow-up was 203.88 Lbs. (SD = 41.04 Lbs.). Hence, on average, the percent total body weight loss at 6-mo is 11.97 after IGBT. The logistic regression performed revealed that weight (β = 0.0140, P < 0.000) and age (β = 0.0534, P < 0.000) are important factors in determining systolic blood pressure after IGBT. None of the other demographic characteristics or indicated comorbidities were found to be significant.


IGBT can be an effective short-term weight reduction modality with a relatively little risk of adverse event. Due to its improvement on systolic blood pressure, IGBT may help reduce cardiovascular risk.

Keywords: Intragastric balloon, Orbera®, Obesity, Hypertension, Systolic blood pressure, Diastolic blood pressure

Core Tip: Obesity is one of the leading causes of preventable life-years lost among Americans. Adults who have obesity compared with adults at a healthy weight have an increased risk of developing serious health conditions including hypertension. The treatment of hypertension in obesity is complicated by a high prevalence of resistant hypertension, as well as unpredictable hemodynamic effects of many medications. Weight loss stabilizes neurohormonal activity and causes clinically significant reductions in blood pressure. While lifestyle interventions can improve blood pressure, they fail to consistently yield sustained weight loss and have not demonstrated long-term benefits. Weight loss promotes dramatic declines in blood pressure and attenuation of long-term cardiovascular risk.