INTRODUCTION: Since 1998, we adopted in our clinical practice for obesity treatment the new intragastric balloon (BioEnterics Intragastric Balloon, BIB®), it has the characteristics of an “ideal gastric balloon” (Workshop Tarpon Springs, 1987). MATERIALS AND METHODS: Since March 1998 we have placed by endoscopic approach 518 BIB in 480 patients affected by first, second and severe morbid obesity; 124 male and 356 female, mean age 41,6 years (18-72), mean weight Kg 116,9 (67-229), mean BMI 42 Kg/m2 (27,34-81,14). All our patients underwent to diet of 1000 Kcal/day and treatment with antisecretory drugs. RESULTS: The mean weight lost was Kg 14,69 and the mean reduction in BMI was 5,11 Kg/m2. Weight loss was greater in male severe obese (BMI > 40). Weight was accompanied by an improvement of the disease associated with obesity, in particular diabetes, hypertension and sleep apnoea. DISCUSSION AND CONCLUSION: The best indication for BIB were: morbidly obese patients (BMI > 40) and super-obese patients (BMI > 50) in preparation for bariatric operation; obese patients with BMI 35-40 with co-morbilities in preparation for bariatric surgery; obese patients with BMI < 30 only in a multidisciplinary approach patients with BMI 30-35 with a chronic disease otherwise unresolved.