Sequential Intragastric Balloon Followed By GLP-1 Receptor Agonist Therapy in Obesity: A Comparative Study of 12-Month Weight Loss Outcomes.

BACKGROUND: Endoscopic and pharmacological therapies are well-established non-surgical options for obesity management. Although combined use of intragastric balloon (IGB) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has demonstrated promising results, most published studies have focused on concurrent administration, which may increase gastrointestinal intolerance. Evidence regarding the effectiveness of a sequential treatment strategy remains limited. METHODS: This retrospective cohort study included adult patients treated with IGB alone, GLP-1 RAs (semaglutide) alone, or a sequential approach consisting of IGB followed by semaglutide between January 2024 and March 2025. In the sequential group, the balloon was removed at 6 months and semaglutide was administered for 3 months thereafter. Primary outcomes were percentage total weight loss (TWL%) at 6 and 12 months. RESULTS: A total of 107 patients were analyzed (IGB n = 37; GLP-1 RAs n = 48; IGB + GLP-1 RAs n = 22). All treatment strategies resulted in clinically meaningful weight loss at 6 months. At 12 months, the sequential IGB + GLP-1 RAs group achieved significantly greater TWL% compared with both IGB and GLP-1 RAs monotherapy (23.4% vs. 13.2% and 8.5%, respectively; p < 0.001). Weight regain between 6 and 12 months was observed in the monotherapy groups, whereas continued weight loss was maintained in the sequential group. CONCLUSIONS: Sequential administration of GLP-1 RAs therapy after intragastric balloon removal was associated with greater weight loss than either therapy alone. These findings suggest that strategic timing of combination therapy, rather than concurrent use, may optimize efficacy in non-surgical obesity management.