To the editor: We agree with the comment of Scheimann and colleagues [1] regarding the difficulties on treating obesity in Prader– Willi syndrome (PWS). We also agree with the concept that obesity should be primarily prevented and treated with supervised reduced-energy diets, restricted access to food, and daily exercise regimen [2]. When pharmacological, dietary, and behavioral approaches fail, however, to control body weight and obesity is progressive and severe (body mass index (BMI) over 40)—as occurs in patients not followed since birth or those referred when the obesity is already severe—the use of Bioenterics Intragastric Balloon (BIB) may represent an alternative and effective treatment for body weight control [3]. In our study [4], younger patients appeared to benefit from treatment more than their older peers, and in the two youngest patients treated more than once, a substantial BMI reduction was maintained during a treatment period of 3 years. In one patient (12.4 years), we were able to maintain a satisfactory BMI control until the age of 17, when he underwent a successful biliopancreatic diversion. BIB, as a totally reversible and repeatable technique, can be used more than once to allow pediatric patients to reach adult age maintaining their BMI as close as possible to normal values. In older patients, BIB can be useful as a preliminary treatment to reduce the risks of a definitive bariatric surgical procedure. Serious complications in BIB appear when a specific postoperative management protocol is not followed. In our experience, all major complications occurred at the beginning of the study as a consequence of the lack of a specifically designed dietary protocol and strict postoperative monitoring. Once this postoperative protocol has been adopted, the complication rate has been significantly reduced and no serious adverse events were observed. With this new protocol and the extensive experience that we now have in our Institute, we have inserted ten BIB over the last 2 years, without any significant complications (data not published). In conclusion, our experience clarifies that to reduce the risk of serious adverse events after BIB, careful selection of patients and families followed by adequate follow-up after implantation is required. Considering that individuals with PWS have an underlying defect in satiety, altered pain threshold, and a decreased ability to vomit with the possibility of gastric rupture [5], a specific postoperative protocol of management must be always adopted, including close postoperative monitoring. Finally, we consider BIB a valid alternative treatment of body weight control only when pharmacological, dietary, and behavioral approaches have failed and obesity is progressive and severe. OBES SURG (2009) 19:674–675 DOI 10.1007/s11695-009-9817-7