Comparative Effectiveness of Three Fluid-Filled Intragastric Balloons for Obesity Management: A Single-Center Retrospective Cohort Study

Objective: Endoscopic bariatric therapies, including intragastric balloons (IGBs) are effective minimally invasive options for obesity management, particularly for patients who are not candidates for bariatric surgery. This study aimed to compare the safety profiles, weight loss outcomes, and tolerability of three fluid-filled IGB systems used in routine clinical practice. Methods: We conducted a retrospective cohort study of adults who underwent intragastric balloon placement at a single private bariatric center between January 2023 and January 2025. Data were derived from a prospectively maintained clinical database. Patients received one of three fluid-filled balloons: Allurion, Medsil, or Spatz3. Baseline demographic and anthropometric characteristics, weight loss outcomes, premature balloon removal, and readmission rates were assessed through completion of treatment. Comparative analyses across balloon types were performed using appropriate parametric and nonparametric statistical tests. Results: A total of 113 patients were included (mean age 34.9 ± 9.3 years; 91.2% female). Mean baseline body mass index (BMI) was 40.0 ± 7.9 kg/m 2 . Balloon distribution was Allurion ( n = 13), Medsil ( n = 40), and Spatz3 ( n = 60). Overall mean absolute weight loss was 14.0 ± 8.3 kg, corresponding to a mean BMI reduction of 5.0 ± 3.0 kg/m 2 . Mean percentage total body weight loss was highest in the Spatz3 group (13.1 ± 7.3%), followed by Medsil (12.0 ± 6.2%) and Allurion (9.8 ± 3.9%); however, differences were not statistically significant ( P = .33). Premature balloon removal due to intolerance occurred in 10.6% of patients, with no significant differences between balloon types. No major complications were observed. Conclusion: All three fluid-filled intragastric balloons demonstrated meaningful weight loss with acceptable safety and tolerability profiles. While the Spatz3 balloon achieved numerically greater weight loss, outcomes were comparable across devices without major adverse events. These findings support the role of IGBs as effective endoscopic bariatric therapies within a comprehensive obesity management framework.