1
|
Alqabandi O, Almutawa Y, AlTarrah D, Alhajeri M, Jamal MH, Almazeedi S. Intragastric balloon insertion and pancreatitis: Case series. Int J Surg Case Rep 2020; 74:263-267. [PMID: 32905925 PMCID: PMC7486575 DOI: 10.1016/j.ijscr.2020.08.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Obesity is a complex multifactorial disease that affects populations worldwide. In Kuwait, the prevalence of obesity is a major public health problem. Intra-Gastric Balloon (IGB) is commonly used as a non-operative strategy among bariatric patients. However, with the increasing use of IGB, life-threatening adverse outcomes are widely reported. PRESENTATION OF CASES A case series five patients presenting with pancreatitis from IGB in Kuwait is reported to better investigate the emerging complications of IGB. Three types of IGB were inserted, these include the Orbera Intragastric Balloon System, Orbera365 Intragastric Balloon System, and the Spatz Adjustable Gastric. The clinical course of balloon pancreatitis is described. DISCUSSION The case series examined existing case reports of IGB associated pancreatitis in the literature, in addition to the investigated clinical outcomes. Patients presented with mild pancreatitis, and removal of balloon resulted in significant improvement in symptoms. Pathogenesis of balloon pancreatitis could be secondary to the pancreas compression by the IGB. CONCLUSION Despite the rarity of balloon pancreatitis, it needs to be recognized as a complication of IGB insertion. Further research is needed to better understand the implications of the balloon size, shape, volume and location of balloon insertion in order to prevent this fatal complication.
Collapse
Affiliation(s)
| | | | - Dana AlTarrah
- Faculty of Public Health, Kuwait University, Kuwait.
| | | | | | | |
Collapse
|
2
|
Stavrou G, Tsaousi G, Kotzampassi K. Life-threatening visceral complications after intragastric balloon insertion: Is the device, the patient or the doctor to blame? Endosc Int Open 2019; 7:E122-E129. [PMID: 30705942 PMCID: PMC6342679 DOI: 10.1055/a-0809-4994] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/26/2018] [Indexed: 12/16/2022] Open
Abstract
Background and aim Intragastric balloon placement is established as a safe, relatively low-cost and well-tolerated minimally invasive procedure for weight loss, giving encouraging results under the strict prerequisite that the obese patient will enroll in a medically supervised weight loss program. This retrospective study reviews already published cases of severe visceral complications for the purpose of assigning responsibility to the device, the patient, or the doctor. Methods We reviewed PubMed and Scopus archived publications describing intragastric balloon (BIB/Orbera)-related severe visceral complications, i. e. perforations and obstructions. Results Twenty-two cases of gastric perforation, two cases of esophageal perforation and 10 cases of bowel obstruction were found. For the gastric perforation the endoscopist was responsible in nine cases, the patient in four, and the balloon itself in nine. For the two cases of esophageal perforation, the endoscopists were responsible, while for the 12 cases of bowel obstruction, the patient was responsible for seven and the device for the other five cases. Conclusion BIB/Orbera balloon insertion remains a safe procedure, with a minimum of complications related to hollow viscera. Mandatory education and accreditation of physicians dealing with bariatric endoscopy and strict supervision of the obese individuals, while living with the balloon, will eliminate such complications.
Collapse
Affiliation(s)
- George Stavrou
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece,Department of General Surgery, York Teaching Hospital, NHS Foundation Trust, York, UK
| | - Georgia Tsaousi
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Katerina Kotzampassi
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece,Corresponding author Katerina Kotzampassi, MD, PhD Department of SurgeryAristotle University of ThessalonikiAHEPA Hospital54006 ThessalonikiGreece+30 2313 303496
| |
Collapse
|
3
|
Barrichello Junior SA, Ribeiro IB, Fittipaldi-Fernandez RJ, Hoff AC, de Moura DTH, Minata MK, de Souza TF, Galvão Neto MDP, de Moura EGH. Exclusively endoscopic approach to treating gastric perforation caused by an intragastric balloon: case series and literature review. Endosc Int Open 2018; 6:E1322-E1329. [PMID: 30410952 PMCID: PMC6221813 DOI: 10.1055/a-0743-5520] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/31/2018] [Indexed: 12/14/2022] Open
Abstract
Background and study aims Obesity is a serious disease, resulting in significant morbidity and mortality. Intragastric balloons (IGBs) have been in use since the 1980s. After the insertion of an IGB, complications such as migration of the device and even severe gastric perforation can occur, requiring laparoscopic surgery. Here, we report three cases of gastric perforation after IGB insertion. In all three cases, the perforation was successfully repaired through an exclusively endoscopic approach.
Collapse
Affiliation(s)
| | - Igor Braga Ribeiro
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | | | | | | | - Mauricio Kazuyoshi Minata
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | - Thiago Ferreira de Souza
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | | | | |
Collapse
|
4
|
Velotti N, Bianco P, Bocchetti A, Milone M, Manzolillo D, Maietta P, Amato M, Buonomo O, Petrella G, Musella M. Acute complications following endoscopic intragastric balloon insertion for treatment of morbid obesity in elderly patients. A single center experience. MINERVA CHIR 2018; 75:72-76. [PMID: 29658677 DOI: 10.23736/s0026-4733.18.07712-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Obesity is a serious disease, with an increasing incidence also among subjects over 60 years old; surgical management has proven to be the most effective in the production of significant and durable weight loss. Intragastric balloon (IGB) treatment promotes a reduction of five to nine Body Mass Index (BMI) units in 6 months with an impressive improvement of obesity-associated comorbidities. METHODS Two hundred and twenty-five patients, 106 men (47.1%) and 119 women (52.9%), were evaluated at our institution to be submitted to a IGB positioning. Of these, 12 patients (8 women and 4 men) were more than 60 years old. For all patients BMI, comorbidities, weight loss and complications were recorded. χ2 test was used to evaluate differences in complications rate between elderly and other patients. RESULTS For the 12 elderly patients, we recorded a mean excess weight loss rate (EWL%) of 31.4. About complications, we recorded 2 severe esophagitis requiring IGB removal and 1 late gastric perforation. A higher complications rate was found in elderly population and the comparison with other patients revealed a significant difference (P<0.001). CONCLUSIONS Our results underline that IGB treatment in elderly patients is safe and effective in terms of weight loss and improvement in comorbidities. IGB can cause complications which, sometimes, can be severe such as esophageal damage and gastric perforation. For the management of complications, we highly recommend a close follow-up in all patients and a deepened instrumental study in every suspect case.
Collapse
Affiliation(s)
- Nunzio Velotti
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy -
| | - Paolo Bianco
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Alessio Bocchetti
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Marco Milone
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Domenico Manzolillo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Paola Maietta
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Maurizio Amato
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Oreste Buonomo
- Department of Surgery, Tor Vergata University, Rome, Italy
| | | | - Mario Musella
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| |
Collapse
|
5
|
Rahman AA, Loi K. Gastric Perforation as a complication of intragastric balloon. Surg Obes Relat Dis 2018; 14:719-722. [PMID: 29475822 DOI: 10.1016/j.soard.2018.01.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 11/27/2022]
Abstract
Obesity is considered the most common nutritional disorder in Western countries and is related to multiple morbidity and mortality. There are different options for obesity treatment, including diet, behavioral therapy, medications, and surgery. If patients do not meet the criteria for bariatric surgery, intragastric balloons may be used to achieve weight reduction. Currently, the intragastric balloon is one of the most common bariatric procedures in obese patients in Europe. Gastric perforation associated with intragastric balloon is a rare but dangerous complication. We report a case of a 42-year-old female patient who presented to the emergency department with acute abdomen. Chest x-ray in an erect posture indicated free gas under the diaphragm. She had undergone placement of an intragastric adjustable balloon device 13 months earlier and was overdue for removal of the balloon. In the emergency theater, a large perforated ulcer was found in the posterior wall of the stomach, which was repaired laparoscopically. Her postoperative course was uneventful. We also review the literature on intragastric balloon-induced gastric perforation. Our case is a very rare report of late gastric perforation after adjustable intragastric balloon placement. We recommend regular follow-up and removal in proper time after insertion of the gastric balloon.
Collapse
Affiliation(s)
- Ahmed Arifur Rahman
- St. George Hospital and The Sutherland Hospital, Kogarah, New South Wales, Australia.
| | - Ken Loi
- St. George Hospital and The Sutherland Hospital, Kogarah, New South Wales, Australia
| |
Collapse
|
6
|
Mojkowska A, Gazdzinski S, Fraczek M, Wyleżoł M. Gastric Ulcer Hemorrhage - a Potential Life-Threatening Complication of Intragastric Balloon Treatment of Obesity. Obes Facts 2017; 10:153-159. [PMID: 28441654 PMCID: PMC5644960 DOI: 10.1159/000456666] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/11/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Some morbidly obese patients do not qualify for bariatric surgery due to general health contraindications. Intragastric balloon treatment might be a therapeutic option in the above-mentioned cases. It can prime super-obese patients with end-stage disease for bariatric surgery. As a neoadjuvant therapy before surgery, it leads to a downstage of the disease by preliminary weight reduction, to an improvement in general health and, in summary, to a reduction of the perioperative risk. It is generally considered to be a safe method. However, due to the wide range of possible complications and unusual symptoms after intragastric balloon treatment, an interdisciplinary, instead of only a surgical or endoscopic, treatment and follow-up might be recommended in these patients. CASE REPORT We here describe a potential life-threatening complication in the form of gastric bleeding as a consequence of intragastric balloon treatment and simultaneous aspirin taking and Helicobacter pylori infection. CONCLUSION There have been reports of some complications of intragastric balloon treatment. However, to the best of our knowledge there were no reports concerning life-threatening hemorrhage from gastric ulcer.
Collapse
Affiliation(s)
- Aleksandra Mojkowska
- *Dr. Aleksandra Mojkowska, Military Institute of Aviation Medicine, 54/56 Krasińskiego Street, 01-755 Warsaw, Poland,
| | | | | | | |
Collapse
|
7
|
Gastric Perforation following Intragastric Balloon Insertion: Combined Endoscopic and Laparoscopic Approach for Management: Case Series and Review of Literature. Obes Surg 2016; 26:1127-32. [PMID: 26992895 DOI: 10.1007/s11695-016-2135-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obesity is a serious disease, with substantial morbidity and mortality. The endoscopic placement of an intragastric balloon (IGB) in association with a low-calorie diet is an option for the treatment of obesity. IGB complications include dislocation of the balloon causing intestinal obstruction, upper gastro-intestinal bleeding and perforation, especially during balloon insertion or removal. Our work aims at decreasing the morbidity of open laparotomy in the management of such gastric perforations. METHODS We report three cases of gastric perforation following IGB insertion that needed surgical intervention. Decision was made to treat them with a minimally invasive combined endoscopic and laparoscopic approach to decrease postoperative morbidity. RESULTS All patients were successfully treated by a minimally invasive approach with less morbidity than the conventional open laparotomy. CONCLUSION Gastric perforation should be suspected in any patient with IGB who presents with an acute abdomen. This can be managed with a minimal invasive approach.
Collapse
|
8
|
|
9
|
Pancreatitis and intragastric balloon insertion. Surg Obes Relat Dis 2015; 12:e33-e34. [PMID: 27050403 DOI: 10.1016/j.soard.2015.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/06/2015] [Accepted: 12/08/2015] [Indexed: 11/23/2022]
|
10
|
Zheng Y, Wang M, He S, Ji G. Short-term effects of intragastric balloon in association with conservative therapy on weight loss: a meta-analysis. J Transl Med 2015; 13:246. [PMID: 26219459 PMCID: PMC4517653 DOI: 10.1186/s12967-015-0607-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 07/16/2015] [Indexed: 01/17/2023] Open
Abstract
Obesity is an epidemic chronic disease which is a risk factor for a number of serious medical conditions. Intragastric balloon, as an alternative, non-surgical treatment approach for the management of obesity, was rejected in previous evidence-based reviews. The object of this review is updating the data and confirming the safety and efficacy of the procedure. In this review, systematic literature retrieve of MEDLINE, EMBASE, CENTRAL and other information sources was performed from inception to December 2014. The quality of selected studies was assessed and meta-analyses of weighted mean differences were made using the inverse variance method. Meta-analyses presented significant effect sizes of -8.9 kg, -3.1 kg/m(2) and -21.0% for SMG as well as of -1.5 kg and -1.2 kg/m(2) for LSG, favoring the intervention group. Safety analysis showed that minor complications occurred at a high rate in intervention group, however, no serious or fatal complication was reported in these studies. In conclusion, the current review presents that short-term efficacy for 6 months treatment of intragastric balloon in association with conservative therapy is clinically significant.
Collapse
Affiliation(s)
- Yiyuan Zheng
- Department of Internal Medicine of Traditional Chinese Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
| | - Miao Wang
- Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
| | - Songhua He
- Department of Internal Medicine of Traditional Chinese Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
| | - Guang Ji
- Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
| |
Collapse
|
11
|
Charalambous MP, Thompson J, Efthimiou E. Late gastric perforation after insertion of intragastric balloon for weight loss--video case report and literature review. Surg Obes Relat Dis 2011; 8:121-3. [PMID: 22100052 DOI: 10.1016/j.soard.2011.09.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 09/05/2011] [Accepted: 09/06/2011] [Indexed: 12/01/2022]
|
12
|
Baigel R, Rashid F, Shrestha D, Ravichandran D. Peritonitis following a bariatric procedure in a young woman. BMJ Case Rep 2011; 2011:2011/feb12_1/bcr1220103602. [PMID: 22707373 DOI: 10.1136/bcr.12.2010.3602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
A 22-year-old woman presented with generalised peritonitis from a gastric perforation due to erosion by an intragastric balloon inserted abroad 22 months previously in an attempt to help her lose weight. These balloons are of uncertain long-term benefit in obesity and should be removed after 6 months to avoid complications. This did not happen in this case; thus, leading to this life-threatening complication, which was treated with the removal of the balloon and omental patch repair of the perforation.
Collapse
Affiliation(s)
- R Baigel
- Department of Surgery, Luton and Dunstable Hospital, Luton, UK
| | | | | | | |
Collapse
|