Guest Commentary: The Boon in the Balloon

In this guest commentary, Pankaj Jay Pasricha, MD, executive committee member and past chair of the AGA Center for GI Innovation and Technology, discusses what FDA approval of the ReShape and ORBERA devices for obesity means to gastroenterologists. Pasricha serves as vice chair of medicine, innovation and commercialization; director, John Hopkins Center for Neurogastroenterology; director, Food, Body and Mind Center; professor of medicine and neurosciences, John Hopkins School of Medicine; and professor of innovation management, John Hopkins Carey School of Business.

Although the gut is an intuitive therapeutic target for obesity, gastroenterologists have played a surprisingly small role in the management of this major health disorder. In part this has been due to the specialty turning away from what had been part of its traditional domain — clinical nutrition — and embracing endoscopic procedures. Ironically, the experience with relatively simple and easy procedures such as colonoscopy and upper endoscopy has also rendered most of us somewhat risk averse and reluctant to embrace procedures that may be more invasive and/or time consuming. Thus, when it comes to the rapidly evolving therapeutic space for the treatment of obesity and metabolic disorders, gastroenterologists seem to have been left out of the party. The recent approvals of ReShape and ORBERA is an invitation for them to join the party … with balloons.

Pankaj Jay Pasricha

These balloons are simple to place, relatively safe and are effective in producing modest weight loss. They are a boon for obese patients who have tried and cannot meet their weight goals without an additional push, but are not ready for surgery and its risk for serious adverse effects. Clearly, these devices can also benefit GI practices by providing an alternative source of revenue particularly at a time when reimbursement for traditional procedures is declining. Further, as gastroenterologists get into this space, even further innovations can be expected, setting up a virtuous cycle of iterative progress.

How should gastroenterologists prepare for this? Most importantly, it would be a mistake to embrace this or other procedures in isolation. It is clear that success with the balloon is a precarious proposition at best without good pre- and post-care in place. Such an investment is not only good business practice, but also in line with the best interpretation of our mission as a cognitive specialty. Further, building such an infrastructure will facilitate the adoption of other procedures and devices that will be emerging from the pipeline in the near future. Finally, gastroenterologists have to build more robust relationships with general practitioners, endocrinologists and other providers taking care of patients with metabolic disorders and position themselves as part of a dedicated health-care team.

Stay tuned for additional guidance from the American Gastroenterological Association on how GIs can realistically implement these procedures into practice.

Disclosure: Pasricha is co-founder of Apollo Endosurgery, the owner of the Orbera device.

Editor's Note: This article was updated on September 14 to reflect the author's relevant financial disclosures.