Intragastric balloons (IGBs) were developed to bridge the gap between lifestyle intervention and Metabolic and Bariatric Surgery (MBS), but the advent of highly efficacious pharmacotherapies and Endoscopic Sleeve Gastroplasty (ESG) has challenged their role. This narrative review synthesises contemporary evidence and guideline recommendations regarding IGBs, focusing on short-term efficacy, durability, safety, psychological aspects, and health system considerations in comparison with Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RAs), dual GIP (Glucose-dependent Insulinotropic Polypeptide)/GLP-1 RAs, ESG, and MBS. Across randomised trials and meta-analyses, IGBs consistently produce modest short-term weight loss of approximately 10-15% total body weight at six months, with frequent weight regain following removal and limited long-term benefit. In contrast, modern pharmacotherapy achieves greater and more durable weight loss with fewer procedural risks. Current guidelines therefore position IGBs as adjunctive or bridging interventions reserved for selected patient subgroups, rather than as a dominant intermediate therapy. Overall, current evidence supports a selective role for IGBs as bridging, adjunctive, or combination interventions within multimodal obesity pathways, particularly for patients who cannot access or tolerate pharmacotherapy or who require a behavioural and metabolic bridge to surgery.
