Gastric balloon (intragastric balloon) explained: types, application, candidacy, and outcomes. Comprehensive guide on Orbera, Spatz3, Allurion Elipse, Obalon by Assoc. Prof. Dr. Hasan Abuoğlu, General Surgery.
Medically reviewed by Assoc. Prof. Dr. Hasan Abuoğlu · June 1, 2026
This article was reviewed on June 1, 2026 by Assoc. Prof. Dr. Hasan Abuoğlu, Associate Professor of General Surgery, in accordance with international endoscopy society guidelines (ESGE, ASGE) and current peer-reviewed literature.
Surgery is not always the first choice in obesity treatment. For individuals who are not yet candidates for bariatric surgery, or who prefer a less invasive approach, the gastric balloon (intragastric balloon) is a temporary, reversible, and non-surgical alternative. This guide comprehensively addresses what the gastric balloon is, what types exist, how it is applied, who is suitable for it, and how it compares to bariatric surgical procedures.
The gastric balloon (medical term: intragastric balloon — IGB) is a balloon made from silicone or similar biocompatible material placed inside the stomach. Filled with liquid (usually saline) or gas, it occupies space in the stomach, allowing the patient to feel satiated with smaller food intake.
| Aspect | Detail |
|---|---|
| Medical name | Intragastric balloon (IGB) |
| Approach | Non-surgical, restrictive |
| Placement | Endoscopic or swallowable |
| Procedure duration | 15-30 minutes |
| Dwell time | 4-12 months (depending on balloon type) |
| Anesthesia | Light sedation or short anesthesia |
| Hospital stay | Typically same-day discharge |
| Reversibility | Fully reversible |
The first gastric balloon was approved by the FDA in 1985, but was withdrawn shortly afterward due to high complication rates. Modern silicone balloons received the CE mark in Europe in 1991 (Orbera/BIB) and FDA approval in 2015. Recent years have brought new generations: swallowable balloons (Allurion Elipse), adjustable balloons (Spatz3), and gas-filled balloons (Obalon).
The gastric balloon works through three primary mechanisms:
The balloon occupies a significant portion of the stomach volume (typically 400-700 ml). This reduces the available space for food and the patient feels satiated with much smaller portions.
The presence of the balloon in the stomach prolongs gastric emptying time. Foods stay in the stomach longer, and the patient experiences extended satiety.
The 4-12 month balloon period helps the patient develop new habits: smaller portions, slower eating, separation of liquid and solid food. These behavioral changes contribute to weight maintenance after balloon removal.
Important: The gastric balloon is not a standalone treatment. It is effective when combined with a nutrition plan, behavioral therapy, and exercise. Expecting lasting results from balloon placement alone, without lifestyle change, is unrealistic.
Several intragastric balloon types are used worldwide. The most common are:
The most studied and widely used gastric balloon.
| Aspect | Detail |
|---|---|
| Placement | Endoscopic |
| Filling | Liquid (saline) — 400-700 ml |
| Dwell time | 6 months (Orbera365 model: 12 months) |
| Approval | CE (1991, Europe), FDA (2015, USA) |
| Removal | Endoscopic |
Clinical data: A meta-analysis of 17 studies including 1,683 patients reported mean Excess Weight Loss (EWL) of 25.44% at 12 months (95% CI: 21.47%-29.41%). Pooled 6-month total body weight loss (TBWL) is 13.16%.
The only balloon whose volume can be adjusted after placement.
| Aspect | Detail |
|---|---|
| Placement | Endoscopic |
| Filling | Liquid — 400-800 ml (adjustable) |
| Dwell time | 12 months |
| Advantage | Volume can be reduced if patient cannot tolerate, increased if weight loss is insufficient |
| Approval | CE (Europe); FDA approval pending in the USA |
Clinical data: A 12-month pilot study with 18 patients reported mean EWL of 48.8%. Adjustability allows treatment continuity in patients with intolerance.
The only balloon that requires no endoscopy for placement and is naturally excreted when its dwell time ends.
| Aspect | Detail |
|---|---|
| Placement | Swallowable capsule (no endoscopy required) |
| Filling | Liquid — approximately 550 ml |
| Dwell time | Approximately 16 weeks (4 months) |
| Removal | Automatic (self-emptying valve releases the balloon, which passes naturally) |
| Approval | CE (Europe); ENLIGHTEN/AUDACITY trials ongoing in USA |
Clinical data: Total body weight loss (TBWL) of 20.1% and EWL of 45.8% have been reported. Avoiding any endoscopic procedure is its primary advantage.
A swallowable, gas-filled (nitrogen) balloon system, available in 1, 2, or 3 balloon configurations.
| Aspect | Detail |
|---|---|
| Placement | Swallowable capsules |
| Filling | Gas (nitrogen) |
| Dwell time | 6 months |
| Removal | Endoscopic (mandatory) |
| Approval | FDA (2016, USA) |
Clinical data: Sullivan et al. 2018 multi-center randomized sham-controlled trial (n=387) showed 6-month TBWL of 7.1% in the Obalon + lifestyle group vs 3.6% in the control group.
A dual balloon system with two connected balloons.
| Aspect | Detail |
|---|---|
| Placement | Endoscopic |
| Filling | Liquid (methylene blue mixed) — 900 ml total (450+450) |
| Dwell time | 6 months |
| Advantage | Dual balloon design reduces deflation-related complications |
| Approval | FDA (2015, USA) |
The 2021 AGA (American Gastroenterological Association) Technical Review concluded:
| Balloon | Placement | Filling | Dwell | Removal |
|---|---|---|---|---|
| Orbera | Endoscopic | Liquid (400-700 ml) | 6 months | Endoscopic |
| Orbera365 | Endoscopic | Liquid (400-700 ml) | 12 months | Endoscopic |
| Spatz3 | Endoscopic | Liquid (400-800 ml) — adjustable | 12 months | Endoscopic |
| Allurion Elipse | Swallowable | Liquid (~550 ml) | 4 months | Naturally passed |
| Obalon | Swallowable | Gas (nitrogen) | 6 months | Endoscopic |
| ReShape Duo | Endoscopic | Liquid (900 ml) — dual balloon | 6 months | Endoscopic |
The gastric balloon may be considered for the following individuals:
Example: A person weighing 80 kg and 1.68 m tall has a BMI of:
Important: The gastric balloon is not a sufficient standalone treatment for morbid obesity (BMI > 40). Surgical options should be evaluated for these patients. The balloon may only be considered as a preoperative or supportive measure.
The gastric balloon is contraindicated in the following conditions:
Clinical evaluation is essential: The lists above provide general guidance. Determining individual eligibility is only possible after detailed medical evaluation including upper gastrointestinal endoscopy.
1. Preparation: The patient is positioned, IV access is established.
2. Sedation: Light sedation or short general anesthesia is administered (per anesthesiologist's evaluation).
3. Diagnostic endoscopy: A gastroscope is passed through the esophagus into the stomach. The stomach and duodenum are inspected for any contraindications (ulcer, hernia, etc.).
4. Balloon placement:
5. Position verification: The balloon is positioned in the appropriate area of the stomach, leakage check is performed.
6. Endoscope withdrawal: The procedure is completed; the patient is moved to the recovery area.
1. Capsule swallowing: The patient swallows a special capsule under physician supervision, with no endoscopy required. The capsule contains the deflated balloon and a thin attached catheter.
2. Inflation: Once positioning in the stomach is confirmed, the balloon is inflated with saline through the catheter.
3. Catheter removal: After inflation, the catheter is gently withdrawn; the balloon remains free in the stomach.
4. Week 16: The self-deflating valve built into the balloon activates; the balloon empties and is naturally passed through the gastrointestinal tract.
| Phase | Duration |
|---|---|
| Preparation and sedation | 15-20 minutes |
| Placement procedure | 15-30 minutes |
| Observation | 1-2 hours |
| Total time at facility | 2-4 hours |
The gastric balloon is typically performed as an outpatient (ambulatory) procedure; most patients are discharged the same day.
| Period | Process |
|---|---|
| First 3-7 days | Most challenging period — nausea, vomiting, stomach cramps possible; clear liquids only |
| Weeks 1-2 | Symptoms decrease; transition to semi-liquid diet |
| After week 2 | Most patients return to normal activities; soft solid food introduced |
| Weeks 4-6 | Full adaptation; period of fastest weight loss begins |
First week warning: Nausea and vomiting are very common (reported in 70-90% of patients). Usually resolves within 5-7 days. Severe and persistent vomiting requires immediate physician contact.
Blood tests:
Imaging and tests:
Consultations:
The following medications are typically prescribed after the procedure:
| Phase | Duration | Content |
|---|---|---|
| Phase 1 | First 2-3 days | Clear liquids (water, tea, broth without particles) |
| Phase 2 | Days 4-7 | Semi-liquids (yogurt, pureed soups, smoothies) |
| Phase 3 | Weeks 1-2 | Soft foods (eggs, fish, cottage cheese, pureed vegetables) |
| Phase 4 | After week 2 | Normal-textured foods (small portions, slow eating) |
| Period | Recommended activity |
|---|---|
| First week | Light walking |
| Weeks 2-4 | Regular walking, yoga, light exercise |
| After 1 month | Cycling, swimming, strength training (gradually) |
Outcomes depending on balloon type and patient adherence:
| Balloon Type | TBWL (Total Body Weight Loss) | EWL (Excess Weight Loss) |
|---|---|---|
| Orbera (6 months) | 11-13% | 25-30% |
| Spatz3 (12 months) | 14-19% | 42-48% |
| Allurion Elipse (4 months) | 13-15% | 29-33% |
| Obalon (6 months) | 6-7% | 15-18% |
| ReShape Duo (6 months) | 7-8% | 18-22% |
Warning: Weight regain after balloon removal is common. Studies report 30-50% weight regain within 1 year after removal. Therefore, lifestyle change during the balloon period is critically important.
Improvement in obesity-related conditions during balloon therapy:
These effects generally appear parallel to weight loss; if weight is regained after balloon removal, comorbidities may also recur.
While not surgical, the gastric balloon is not without risks.
Most of these symptoms resolve within 5-7 days.
In 5-10% of patients, the balloon may need to be removed early:
| Feature | Gastric Balloon | Sleeve Gastrectomy | Gastric Bypass |
|---|---|---|---|
| Approach | Non-surgical | Surgical (permanent) | Surgical (permanent) |
| Method | Endoscopic/swallowable | Laparoscopic | Laparoscopic |
| Procedure time | 15-30 min | 60-90 min | 90-150 min |
| Hospital stay | Same day | 2-3 days | 3-4 days |
| Duration/Reversibility | 4-12 months (temporary) | Not reversible | Technically very difficult to reverse |
| TBWL (1 year) | 10-15% | 25-30% | 30-35% |
| EWL (1 year) | 25-45% | 60-70% | 65-75% |
| Type 2 diabetes effect | Limited | Significant improvement | Very significant improvement |
| Vitamin malabsorption | None | Less | More |
| BMI recommendation | 27-35 | ≥35 (or ≥30 + comorbidity) | ≥35 (or ≥30 + comorbidity) |
| Weight regain after 1 year | 30-50% | 5-15% | 5-15% |
| Risk profile | Low | Moderate | Moderate-High |
Summary: The gastric balloon is a temporary tool for non-surgical weight loss. Compared to surgical methods, it is less invasive, provides less weight loss, and has limited long-term durability. With appropriate candidate selection and lifestyle support, it can be a valuable treatment option.
The placement procedure is painless under sedation. The first 3-7 days of adjustment may include cramps, nausea, and vomiting. These symptoms are managed with medication and usually resolve within a week.
No. The gastric balloon is temporary. Dwell time ranges from 4-12 months depending on the balloon type. It must be removed at the end of its dwell period; leaving it longer increases the risk of deflation and complications.
Yes, weight regain is common. Studies have observed 30-50% regain within 1 year. For this reason, changes in eating habits and ongoing exercise during the balloon period are critically important.
"Better" is subjective. The Allurion Elipse offers a significant advantage for patients who want to avoid endoscopy. However, dwell time is shorter (4 months vs 6-12 months) and volume is fixed (not adjustable). Each patient's situation determines the optimal balloon choice.
Insurance coverage varies by country and individual policy. Patients should consult their insurance provider for specific information.
Most patients can return to office work within 3-5 days. Those in physically demanding jobs may need 7-10 days. Nausea and fatigue are common during the first week.
Pregnancy is not recommended during gastric balloon therapy. Rapid weight loss and reduced caloric intake may pose risks for mother and baby. If pregnancy is planned, balloon should be removed and pregnancy considered at least 3-6 months later.
Yes, sequential balloons are possible. Some protocols allow a second balloon to be placed after a 2-3 month break. Used to support continued weight loss and lifestyle change. However, each additional balloon slightly increases complication risk.
Yes. In high-BMI patients (especially BMI > 50), a preoperative balloon can achieve 10-20 kg loss prior to surgery, reducing anesthesia and surgical risk. This approach has become more common in recent years.
The balloon provides a constant sense of fullness and slight bloating. Food intake notably decreases. If the balloon deflates or migrates, urine may turn blue/green (due to methylene blue contents) — in this case, contact a physician immediately.
The gastric balloon is a non-surgical, reversible, and temporary option in obesity treatment. With appropriate candidate selection (BMI 27-35), suitable balloon type, and lifestyle change support, valuable outcomes can be achieved. However, limited weight loss compared to surgical methods and risk of weight regain after removal are important limitations.
The gastric balloon is not a treatment alone, but a tool. When combined with dietitian support, behavioral therapy, and regular exercise, successful results can be achieved. The balloon period should be considered not just a time for weight loss, but a learning process where the foundation for lasting lifestyle change is laid.
For detailed information and individualized evaluation, consultation with a general surgeon or gastroenterologist experienced in bariatric care is recommended.
⚠️ Important Notice (in accordance with Turkish Healthcare Promotion Regulation, Official Gazette No. 33075, Article 7/k): Outcomes of any surgical or interventional procedure may vary from person to person. Patients are advised to obtain detailed consultation from their physician before undergoing any procedure.
AGA Technical Review on Intragastric Balloons in the Management of Obesity. Gastroenterology. 2021. American Gastroenterological Association.
Intragastric Balloon — StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. NBK578184
Current status of intragastric balloon for obesity treatment. World J Gastroenterol. 2016. PMC4917609
Various Intragastric Balloons Under Clinical Investigation. Obes Surg. 2018. PMC6182294
Six intragastric balloons: Which to choose? World J Gastrointest Endosc. 2021. PMC8394181
Sullivan S, et al. A Multi-Center Randomized Sham-Controlled Trial of the 6-Month Swallowable Gas-Filled Intragastric Balloon System for Weight Loss. Surg Obes Relat Dis. 2018.
Intragastric balloons for obesity: critical review of device design, efficacy, tolerability, and unmet clinical needs. Expert Rev Med Devices. 2024.
ESGE-ASGE 2024 Joint Guideline. Bariatric and Metabolic Endoscopy. Endoscopy. 2024.
Healthcare Advertising and Information Activities Regulation. Turkish Official Gazette, November 12, 2025, No. 33075.
Author and Medical Reviewer: Assoc. Prof. Dr. Hasan Abuoğlu — Associate Professor of General Surgery
Health Tourism Authorization Number: ST-2697 (Republic of Türkiye, Ministry of Health)
Published: June 1, 2026 Last updated: June 1, 2026 Editorial contact: contact@drhasanabuoglu.com
This content is for informational purposes only and does not substitute for medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for medical decisions.
Assoc. Prof. Dr. Hasan Abuoğlu
General Surgery · Bariatric and Metabolic Surgery
General surgeon with over 25 years of experience and 10,000+ laparoscopic bariatric procedures. IFSO member.
Medical Disclaimer: This content is for informational purposes only. Please consult your doctor for personal medical advice.
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Assoc. Prof. Dr. Hasan Abuoğlu
Associate Professor of General Surgery
