Effectiveness of combined intragastric balloon therapy and GLP-1 receptor agonists for weight loss in adults with obesity: a systematic review and meta-analysis

Vásquez-Tirado G.A.; Villarreal-Jara M.F.; Meregildo-Rodríguez E.D.; Quispe-Castañeda C.V. · Obesity Medicine (2026) · DOI: 10.1016/j.obmed.2026.100697

Resumen

Background Intragastric balloon (IGB) therapy and glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonist) are effective, minimally invasive interventions for obesity. Whether combining both strategies improves 12-month weight outcomes compared with IGB alone remains uncertain. Methods We performed a systematic review and meta-analysis (PROSPERO CRD420261278166) in accordance with the Cochrane Handbook and PRISMA 2020. MEDLINE (PubMed), Scopus, EMBASE, Web of Science, ScienceDirect, and the Cochrane Library were searched from inception to 5 December 2025. We included randomized and observational studies enrolling adults (≥18 years; BMI ≥30 kg/m2) treated with IGB plus a GLP-1 receptor agonists (concurrently with balloon placement or sequentially after balloon removal) versus IGB alone. Primary outcomes were 12-month percentage total body weight loss (%TWL) and percentage excess weight loss (%EWL). Secondary outcomes included weight regain and adverse events (nausea/vomiting). Random-effects models (REML with Hartung–Knapp adjustment) were used; continuous outcomes were pooled as standardized mean differences (SMDs) and dichotomous outcomes as odds ratios (ORs). Results Seven studies (n = 581; 255 IGB + GLP-1 receptor agonists vs 326 IGB alone) were included. GLP-1 receptor agonists were liraglutide (four studies) and semaglutide (three studies; mostly subcutaneous, one oral). At 12 months, there was no significant difference between groups for %TWL (SMD 3.44; 95% CI −5.44 to 12.11; I2 = 98.5) or %EWL (SMD 3.36; 95% CI −40.28 to 46.99; I2 = 98.3). No significant difference was observed at 6 months for %TWL (SMD 0.95; 95% CI −1.56 to 3.46; I2 = 95.1), for weight regain at 12 months (SMD −1.90; 95% CI −20.05 to 16.26; I2 = 96.4), or for nausea/vomiting (OR 1.36; 95% CI 0.84 to 2.19; I2 = 0). No eligible studies evaluated tirzepatide. Conclusions Current evidence does not demonstrate a statistically significant incremental 12-month weight-loss benefit from adding a GLP-1 receptor agonists to IGB compared with IGB alone. High heterogeneity and inconsistent outcome reporting limit certainty; adequately powered trials with standardized endpoints and contemporary incretin-based agents are needed.

Instituciones: Universidad Peruana Cayetano Heredia; Universidad Privada Antenor Orrego