Background

Intermittent vagal blockade (Vbloc) and intragastric balloons are alternative, minimally invasive, weight loss procedures. Our aim was to examine their use in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).

Methods

We analyzed data from the MBSAQIP 2017 30-day outcome database, which flags patients who received a Vbloc or intragastric balloon. Principal procedure CPT codes were used to identify patients undergoing bariatric surgery. Patients with device and bariatric surgery were compared for demographics, pre-operative BMI and comorbidities by Student’s t-test (continuous variables) or chi-square (categorical variables).

Results

In 2017, 1600 (8%) patients underwent device placement (balloon 1527, Vbloc 69, both 4) while 198379 had bariatric surgery. Mean age and gender distribution were similar and most were white in both groups. Lifetime maximum BMI (mean±SD, 46.4±8.7 vs 37.4±6.6 kg/m2) and pre-operative BMI (44.5±8.2 vs 36.0±6.7 kg/m2) were lower in patients with device placement (both p<0.001). Consistently, fewer patients in the device group had comorbidities: type 2 diabetes 10.7 vs 24.4%; hyperlipidemia 13.4 vs 22.4%; hypertension 24.6 vs 46.6%; obstructive sleep apnea 12.8 vs 35.6%. No difference was seen in 30-day mortality and reoperation rate, but device placement led to fewer readmissions (1.4 vs 4%). A subset of patients with device flag (n=340) underwent bariatric surgery. They did not differ from the rest of the device group in terms of age, sex, race, lifetime maximum BMI and pre-operative BMI.

Conclusions

Based on MBSAQIP data, a minority of patients underwent placement of Vbloc or intragastric balloon in 2017, and bariatric surgery was still the leading weight loss procedure. Patients receiving a weight loss device had lower baseline BMI and fewer comorbidities than those undergoing bariatric surgery. Surprisingly, despite less severe obesity than the bariatric group, some patients had both device placement and bariatric surgery.