1
|
de Moura DTH, Sánchez-Luna SA, Silva AF, Bestetti AM. Intragastric Balloons: Practical Considerations. Gastrointest Endosc Clin N Am 2024; 34:687-714. [PMID: 39277299 DOI: 10.1016/j.giec.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
Obesity is escalating, projected to affect 17.5% of adults globally and afflict 400 million children by 2035. Managing this intricate and chronic condition demands personalized, multidisciplinary approaches. While dietary changes, lifestyle modifications, and medications yield short-term results, long-term outcomes are often poor, with bariatric surgery standing out as the most effective option. However, only a small fraction undergoes surgery due to various barriers. Intragastric balloon (IGB) emerges as a minimally invasive alternative, approved by major regulatory bodies. This review adresses the pivotal role of IGB in obesity management, delving into its history and technological evolution.
Collapse
Affiliation(s)
- D T H de Moura
- Gastrointestinal Endoscopy Division, Instituto D´Or de Pesquisa e Ensino (IDOR), Hospital Vila Nova Star, R. Dr. Alceu de Campos Rodrigues, 126 - Vila Nova Conceição, São Paulo, São Paulo 04544-000, Brazil; Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 Cerqueira César, 05403-000, Brazil.
| | - Sergio A Sánchez-Luna
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, Basil I. Hirschowitz Endoscopic Center of Excellence, The University of Alabama at Birmingham Heersink School of Medicine, 510 20th Street S, LHFOT 1203, Birmingham, AL 35294, USA
| | - Adriana Fernandes Silva
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 Cerqueira César, 05403-000, Brazil
| | - Alexandre Moraes Bestetti
- Gastrointestinal Endoscopy Division, Instituto D´Or de Pesquisa e Ensino (IDOR), Hospital Vila Nova Star, R. Dr. Alceu de Campos Rodrigues, 126 - Vila Nova Conceição, São Paulo, São Paulo 04544-000, Brazil; Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 Cerqueira César, 05403-000, Brazil
| |
Collapse
|
2
|
Mohamed MW, Alkhater NR, Abubaker FO, Sharif OE. The Efficacy, Tolerance, and Adverse Events of Endoscopic Intragastric Balloon in Obese and Overweight Patients: A Retrospective Cross-Sectional Study. Cureus 2024; 16:e56528. [PMID: 38646333 PMCID: PMC11026998 DOI: 10.7759/cureus.56528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Obesity is a pandemic causing a significant burden on healthcare systems and carries increased morbidity and mortality. One of the options for managing obesity is endoscopic intragastric balloon (IGB) insertion. The aim of the study is to assess the efficacy, tolerance, and side effects of IGB insertion in overweight and obese patients. Methods This is a cross-sectional retrospective study that includes 71 patients who underwent IGB insertion from 2015 to 2019 at King Hamad University Hospital (KHUH), Kingdom of Bahrain. Records of these patients were accessed to assess the percentage of weight loss at the time of balloon removal, complications, and tolerance of the procedure. Furthermore, telephonic interviews were conducted to enquire about side effects and the satisfaction of the procedure. Results A total of 57 patients were included in the weight loss analysis. Thirteen patients did not tolerate the balloon, and one patient had a balloon rupture. The patients experienced a significant reduction in weight upon balloon removal with a mean of 9.74 ± 8.71 kg (p-value of <0.001) and percentage total body weight loss of 10.48 ± 8.07 (p-value of <0.001). A significant reduction was also seen in the body mass index of 3.67 ± 3.57 (p-value of <0.001). The most frequent side effects were nausea, vomiting, and abdominal pain. No major complications or mortalities occurred. Conclusion Intragastric balloons are effective in establishing weight loss. Among patients who tolerated the procedure, the most frequently reported side effects were nausea, vomiting, and abdominal pain.
Collapse
Affiliation(s)
| | - Noora R Alkhater
- Internal Medicine, King Hamad University Hospital, Muharraq, BHR
| | - Faisal O Abubaker
- Gastroenterology and Hepatology, King Hamad University Hospital, Muharraq, BHR
| | - Omar E Sharif
- Gastroenterology and Hepatology, King Hamad University Hospital, Muharraq, BHR
| |
Collapse
|
3
|
Ameen S, Merchant HA. Intragastric balloons for obesity: critical review of device design, efficacy, tolerability, and unmet clinical needs. Expert Rev Med Devices 2024; 21:37-54. [PMID: 38030993 DOI: 10.1080/17434440.2023.2289691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Sustaining a healthy weight is a challenge and obesity, with associated risk of co-morbidities, is a major public health concern. Bariatric surgery has shown a great promise for many where pharmacological and lifestyle interventions failed to work. However, challenges and limitations associated with bariatric surgery has pushed the demand for less invasive, reversible (anatomically) interventions, such as intragastric balloons (IGBs). AREAS COVERED This review critically appraises IGBs used in the past, present, and those in clinical trials, discussing the device designs, limitations, placement and removal techniques, patient eligibility, efficacy, and safety issues. EXPERT OPINION Several intragastric balloons were developed over the years that brought excitement to patients and healthcare professionals alike. Albeit good efficacy, there had been several safety issues reported with IGBs such as spontaneous deflation, intestinal occlusion, gut perforation, and mucosal ulcerations. This led to evolution of IGBs design; device material, filling mechanism, fluid type, inflation volume, and further innovations to ease ingestion and removal of device. There are some IGB devices under development aimed to swallow like a conventional pill and excrete naturally through defecation, however, how successful they will be in clinical practice in terms of their efficacy and tolerability remains to be seen in the future.
Collapse
Affiliation(s)
- Sara Ameen
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, West Yorkshire, UK
| | - Hamid A Merchant
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, West Yorkshire, UK
- Department of Bioscience, School of Health, Sport and Bioscience, University of East London, London, UK
| |
Collapse
|
4
|
Avci E, Ay S. Results of intragastric balloon treatment and evaluation of patient satisfaction. J Minim Access Surg 2023; 19:493-497. [PMID: 37357492 PMCID: PMC10695307 DOI: 10.4103/jmas.jmas_353_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/12/2023] [Accepted: 02/02/2023] [Indexed: 06/27/2023] Open
Abstract
Introduction Endoscopic bariatric therapies are an alternative treatment method for patients who do not respond to diet, exercise and drug therapy or who are not yet candidates for surgery or who are suitable and hesitant to undergo surgery. In this study, we aimed to evaluate our intragastric balloon (IGB) treatment results and the satisfaction of the patients in the light of the literature. Materials and Methods The study was conducted by retrospectively evaluating the patients who underwent IGB application in the gastroenterology and general surgery endoscopy units of our hospital. Results Sixty-eight patients who had IGB for 6 months were evaluated. The mean weight given was 10 (0-25) kg and the mean body mass index (BMI) decrease was 3.6 (0-9) kg/m2. A statistically significant decrease was obtained between the initial weight and BMI of our patients and the weight and BMI at the end of the 6th month (P ≤ 0.0001). Thirty-five (51.5%) patients reported that they were satisfied with the procedure, while 33 (48.5) reported that they were not satisfied. conclusion IGBs for the treatment of obesity are an attractive form of treatment because they provide minimally invasive, temporary and significant weight loss. Patients need to be repeatedly told that diet and lifestyle changes should be followed in the treatment of IGB. Thus, we believe that possible disappointments can be prevented.
Collapse
Affiliation(s)
- Enver Avci
- Department of Gastroenterology, KTO Karatay University Medical School Medicana Affiliated Hospital, Konya, Türkiye
| | - Serden Ay
- Department of General Surgery, KTO Karatay University Medical School Medicana Affiliated Hospital, Konya, Türkiye
| |
Collapse
|
5
|
Wang S, Miranda F, Wang Y, Rasheed R, Bhatt T. Near-Fall Detection in Unexpected Slips during Over-Ground Locomotion with Body-Worn Sensors among Older Adults. SENSORS (BASEL, SWITZERLAND) 2022; 22:3334. [PMID: 35591025 PMCID: PMC9102890 DOI: 10.3390/s22093334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/13/2022] [Accepted: 04/21/2022] [Indexed: 06/15/2023]
Abstract
Slip-induced falls are a growing health concern for older adults, and near-fall events are associated with an increased risk of falling. To detect older adults at a high risk of slip-related falls, this study aimed to develop models for near-fall event detection based on accelerometry data collected by body-fixed sensors. Thirty-four healthy older adults who experienced 24 laboratory-induced slips were included. The slip outcomes were first identified as loss of balance (LOB) and no LOB (NLOB), and then the kinematic measures were compared between these two outcomes. Next, all the slip trials were split into a training set (90%) and a test set (10%) at sample level. The training set was used to train both machine learning models (n = 2) and deep learning models (n = 2), and the test set was used to evaluate the performance of each model. Our results indicated that the deep learning models showed higher accuracy for both LOB (>64%) and NLOB (>90%) classifications than the machine learning models. Among all the models, the Inception model showed the highest classification accuracy (87.5%) and the largest area under the receiver operating characteristic curve (AUC), indicating that the model is an effective method for near-fall (LOB) detection. Our approach can be helpful in identifying individuals at the risk of slip-related falls before they experience an actual fall.
Collapse
Affiliation(s)
- Shuaijie Wang
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, USA; (S.W.); (Y.W.)
| | - Fabio Miranda
- Department of Computer Science, University of Illinois at Chicago, Chicago, IL 60607, USA; (F.M.); (R.R.)
| | - Yiru Wang
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, USA; (S.W.); (Y.W.)
| | - Rahiya Rasheed
- Department of Computer Science, University of Illinois at Chicago, Chicago, IL 60607, USA; (F.M.); (R.R.)
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, USA; (S.W.); (Y.W.)
| |
Collapse
|
6
|
Wang Y, Kassab GS. Efficacy and Mechanisms of Gastric Volume-Restriction Bariatric Devices. Front Physiol 2021; 12:761481. [PMID: 34777019 PMCID: PMC8585502 DOI: 10.3389/fphys.2021.761481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/07/2021] [Indexed: 12/27/2022] Open
Abstract
Obesity is a chronic disease that affects over 795 million people worldwide. Bariatric surgery is an effective therapy to combat the epidemic of clinically severe obesity, but it is only performed in a very small proportion of patients because of the limited surgical indications, the irreversibility of the procedure, and the potential postoperative complications. As an alternative to bariatric surgery, numerous medical devices have been developed for the treatment of morbid obesity and obesity-related disorders. Most devices target restriction of the stomach, but the mechanism of action is likely more than just mechanical restriction. The objective of this review is to integrate the underlying mechanisms of gastric restrictive bariatric devices in obesity and comorbidities. We call attention to the need for future studies on potential mechanisms to shed light on how current gastric volume-restriction bariatric devices function and how future devices and treatments can be further improved to combat the epidemic of obesity.
Collapse
Affiliation(s)
- Yanmin Wang
- California Medical Innovations Institute, San Diego, CA, United States
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, CA, United States
| |
Collapse
|
7
|
Gazdzinski SP, Mojkowska A, Gaździńska A, Gorycka M, Zieliński P, Pacho R. Gray matter volume increases induced by intragastric balloon treatment and their associations with neuroinflammation: A magnetic resonance study. Obes Res Clin Pract 2021; 15:455-460. [PMID: 34426101 DOI: 10.1016/j.orcp.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/22/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We simultaneously performed structural MRI, 1H magnetic resonance spectroscopy, and whole-body hydration status assessment to evaluate brain changes in patients with morbid obesity treated with intra-gastric balloon (IGB) for six months. We asked, if changes in myo-inositol ratios (marker of neuroinflammation) are related to brain volume increases accompanying IGB-induced weight loss. METHODS Twenty five patients with morbid obesity (OB, 43.9 ± 11.8 years, BMI = 49.1 ± 7.2, 12 females, 9 without co-morbid conditions) were treated with IGB for six months. They underwent magnetic resonance imaging at 3T one month before IGB insertion, three months after insertion (N = 19), and one month after IGB removal (N = 14). RESULTS Insertion of IGB lead to 8.9% and 12.3% weight reduction over the first three months and over the entire treatment, respectively. Over the entire treatment, total gray matter volume increased by 2.0% (p = 0.009). These changes were mostly pronounced in the left precuneus and in the right frontal pole (>1.9%, p < 0.009). The increases in cortical volume in the right hemisphere and the left posterior cingulate cortical thickness over the entire treatment were significantly related to decreases in myo-inositol ratios measured over the first three months of the treatment (r < -0.740, p < 0.006). CONCLUSIONS IGB treatment lead to brain structural improvements consistent with earlier studies of bariatric patients without co-morbid conditions. Our results also pointed to improvements in brain regions, where atrophy in other studies was related to type 2 diabetes and hypertension. The correlations point to neuroinflammation as one of the potential processes behind brain volume reductions in patients with morbid obesity.
Collapse
Affiliation(s)
| | - Aleksandra Mojkowska
- Military Institute of Aviation Medicine, Warsaw, Poland; Department of General, Gastroenterological, and Oncological Surgery Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland.
| | | | - Maria Gorycka
- Military Institute of Aviation Medicine, Warsaw, Poland
| | | | - Ryszard Pacho
- Military Institute of Aviation Medicine, Warsaw, Poland; Department of Radiology, Warsaw Medical University, Poland
| |
Collapse
|
8
|
A Preclinical Animal Study of Combined Intragastric Balloon and Duodenal-Jejunal Bypass Liner for Obesity and Metabolic Disease. Clin Transl Gastroenterol 2021; 11:e00234. [PMID: 33094961 PMCID: PMC7508443 DOI: 10.14309/ctg.0000000000000234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION: Endoscopic bariatric and metabolic therapies can potentially reproduce similar gastric and small intestinal anatomic and physiologic manipulations as Roux-en-Y gastric bypass. This proof of concept animal study was aimed to assess the feasibility, safety, efficacy, and impact on gastrointestinal physiology of combined intragastric balloons (IGB) and duodenal-jejunal bypass liner (DJBL) for the treatment of obesity. METHODS: Five Ossabaw pigs were fed a high-calorie diet to develop obesity and were randomly assigned to receive IGB or DJBL in sequence. The weight gain rate was calculated. Fasting and postprandial blood samples were drawn before any intervention (serving as the baseline group) and 1 month after second device insertion (serving as the combination group) to measure gut neurohormonal changes and metabolic parameters. RESULTS: Four pigs successfully received a sequential device insertion. One pig developed duodenal sleeve prolapse that was spontaneously resolved. One pig was early terminated because of developing a central line infection. The rate of weight gain in the combination group (0.63 ± 1.3 kg/wk) was significantly lower than the baseline group (1.96 ± 2.17 kg/wk) and numerically lower than after insertion of the IGB (1.00 ± 1.40 kg/wk) or the DJBL (0.75 ± 2.27 kg/wk) alone. A trend of higher postprandial glucagon-like peptide-1 was observed in the combination group compared with the baseline group. DISCUSSION: A combination of IGB and DJBL is feasible and well tolerated. A strategy of sequential use of these devices might offer a synergistic approach that can enhance weight loss and metabolic outcomes.
Collapse
|
9
|
Mathus-Vliegen E, Spångeus A, Walter S, Ericson AC. Weight loss with or without intragastric balloon causes divergent effects on ghrelin cell expression. Obes Sci Pract 2021; 7:199-207. [PMID: 33841889 PMCID: PMC8019283 DOI: 10.1002/osp4.478] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/03/2020] [Accepted: 12/09/2020] [Indexed: 12/11/2022] Open
Abstract
Objective The mechanism of action of intragastric balloons in the treatment of obesity is not fully understood. One of the hypotheses is that balloons might have an effect on the fundus, the area of ghrelin production. Methods Participants were randomized to a 13‐week period of sham or balloon treatment followed by a 13‐week period of balloon therapy in everyone. Blood samples for ghrelin levels were taken in the fasting state and after a breakfast at the start, after 13 and 26 weeks. Biopsies for ghrelin cell immunohistochemistry were taken from the fundus at endoscopy. Results Seven participants entered the balloon–balloon (BB) group and 11 the sham–balloon (SB) group. Despite a considerable weight loss, a median −17.9 kg (interquartile ranges −23.8 to −0.5) in the BB group and −18.3 kg (−22.7 to −14.7) in the SB group, fasting ghrelin and meal‐induced ghrelin response did not change. In the SB group, the number of ghrelin cells increased significantly (p 0.001) from 110.6 (83.6–118.9) to 160.2 (128.5–223.0) while on sham treatment and returned to initial levels, 116.3 (91.7–146.9) (p 0.001), when they received their first balloon. No significant changes in ghrelin cell numbers were observed in the BB group. Conclusion In participants without a balloon, weight loss induced an increase in ghrelin cell numbers in the fundus, which was annulled by the subsequent placement of a balloon. The effect of a balloon might be explained by effects on ghrelin cell numbers or ghrelin cell activity.
Collapse
Affiliation(s)
- Elisabeth Mathus-Vliegen
- Department of Gastroenterology and Hepatology Academic Medical Centre (AMC) University of Amsterdam Amsterdam the Netherlands
| | - Anna Spångeus
- Department of Health, Medicine and Caring Sciences Division of Diagnostics and Specialist Medicine Linköping University Linköping Sweden.,Department of Acute Internal Medicine and Geriatrics Linköping University Hospital Linköping University Linköping Sweden
| | - Susanna Walter
- Department of Biomedical and Clinical Sciences Division of Inflammation and Infection Medical Faculty Linköping University Linköping Sweden.,Department of Gastroenterology Linköping University Hospital Linköping University Linköping Sweden
| | - Ann-Charlott Ericson
- Department of Biomedical and Clinical Sciences Division of Molecular Medicine and Virology Medical Faculty Linköping University Linköping Sweden
| |
Collapse
|
10
|
Goyal H, Kopel J, Perisetti A, Mann R, Ali A, Tharian B, Saligram S, Inamdar S. Endobariatric procedures for obesity: clinical indications and available options. Ther Adv Gastrointest Endosc 2021; 14:2631774520984627. [PMID: 33629061 PMCID: PMC7841245 DOI: 10.1177/2631774520984627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/03/2020] [Indexed: 12/18/2022] Open
Abstract
Obesity remains a growing public health epidemic that has increased healthcare costs and related comorbidities. Current treatment guidelines encourage a multidisciplinary approach starting from patient selection, interventions, and long-term follow-up to maintain weight loss. However, these conservative interventions are largely ineffective at reducing body weight due to low adherence to the treatment regimen. Recently, endoscopic bariatric therapies have become an attractive alternative to traditional invasive bariatric surgeries due to their improved efficacy, safety, and cost-effectiveness. Endoscopic bariatric therapies include intragastric balloon placement, endoscopic sleeve gastroplasty, gastric bypass revision, and aspiration therapy. These procedures fall into two separate categories depending on the primary mechanism involved: restrictive or malabsorptive. Restrictive methods, such as the Orbera® and ReShape™ intragastric balloons, increase satiation and delay gastric emptying while decreasing the amount of food that can be ingested. In contrast, malabsorptive devices, such as the EndoBarrier®, interfere with the small intestine's ability to absorb food while restoring normal gastrointestinal hormone levels regulating satiation. Together, these techniques provide useful alternatives for patients in whom pharmacological or lifestyle modifications have proven ineffective. Despite these advantages, the long-term effects of these procedures on metabolic changes remain to be studied. Furthermore, the management of complications from these procedures continues to evolve. In this review, we aim to elaborate on the clinical indications and efficacy of the endobariatric procedures, together with various types of available endoscopic bariatric therapy procedures.
Collapse
Affiliation(s)
- Hemant Goyal
- The Wright Center for Graduate Medical
Education, 501 South Washington Avenue, Scranton, PA 18505, USA
| | - Jonathan Kopel
- Department of Medicine, Texas Tech University
Health Sciences Center, Lubbock, TX, USA
| | - Abhilash Perisetti
- Department of Gastroenterology and Hepatology,
University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rupinder Mann
- Department of Internal Medicine, Saint Agnes
Medical Center, Fresno, CA, USA
| | - Aman Ali
- The Commonwealth Medical College, Wilkes Barre
General Hospital, Wilkes-Barre, PA, USA
| | - Benjamin Tharian
- University of Arkansas for Medical Sciences,
Little Rock, AR, USA
| | - Shreyas Saligram
- Division of Advanced Endoscopy,
Gastroenterology, Hepatology, and Nutrition, Department of Medicine,
University of Texas Health San Antonio, San Antonio, TX, USA
| | - Sumant Inamdar
- University of Arkansas for Medical Sciences,
Little Rock, AR, USA
| |
Collapse
|
11
|
Cho JH, Bilal M, Kim MC, Cohen J. The Clinical and Metabolic Effects of Intragastric Balloon on Morbid Obesity and Its Related Comorbidities. Clin Endosc 2021; 54:9-16. [PMID: 33684281 PMCID: PMC7939781 DOI: 10.5946/ce.2020.302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 12/16/2022] Open
Abstract
Obesity is becoming increasingly prevalent worldwide, and its metabolic sequelae lead to a significant burden on healthcare resources. Options for the management of obesity include lifestyle modification, pharmacological treatment, surgery, and endoscopic bariatric therapies (EBTs). Among these, EBTs are more effective than diet and lifestyle modification and are less invasive than bariatric surgery. In recent years, there have been significant advances in technologies pertaining to EBTs. Of all the available EBTs, there is a significant amount of clinical experience and published data regarding intragastric balloons (IGBs) because of their comparatively long development period. Currently, the United States Food and Drug Administration (FDA) has approved three IGBs, including Orbera (Apollo Endosurgery, Austin, TX, USA), ReShape Duo (ReShape Medical, San Clemente, CA, USA), and Obalon (Obalon Therapeutics, Carlsbad, CA, USA). The aim of this review is to summarize the available literature on the efficacy of IGBs in weight loss and their impact on obesity-related metabolic diseases.
Collapse
Affiliation(s)
- Joon Hyun Cho
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Mohammad Bilal
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Min Cheol Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Jonah Cohen
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - The Study Group for Endoscopic Bariatric and Metabolic Therapies of the Korean Society of Gastrointestinal Endoscopy
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW This review was conducted to gain insight into the history, present and future of bariatric and/or metabolic surgery and endoscopic treatments of obesity. The challenges that have been overcome, the challenges we still face and our recommendations for the future are discussed. RECENT FINDINGS Over the last few decades, a number of treatment strategies have emerged for the treatment of obesity. Both endoscopic and surgical options are available and they lead to significant weight loss and comorbidity reduction. However, to remain a credible treatment alternative to the obesity pandemic, we need to perform these procedures in much larger numbers than we currently do. Even though significant gains have been made in reducing the morbidity and mortality of surgical interventions, there is further room for improvement, especially when it comes to long-term issues. Due to its impact on almost every single organ system in the human body, bariatric surgery has attracted the attention of academics from a variety of medical disciplines. This has led to a rapidly enlarging body of high-quality scientific literature, supporting its wider use and cost-effectiveness. CONCLUSION Despite the advances made in bariatric surgery, the criteria determining suitability of patients for bariatric surgery in most parts of the world are still based on a consensus agreed upon in the USA in 1991. There is a need to formulate some new consensus and guidelines that would allow for a significant expansion of the pool of patients that can be offered these procedures.
Collapse
Affiliation(s)
- Edo O Aarts
- Praeclarum, Obesity Treatment, Oosterbeek, The Netherlands.
| | - Kamal Mahawar
- Bariatric Unit, Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK.
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK.
| |
Collapse
|
13
|
Guedes MR, Fittipaldi-Fernandez RJ, Diestel CF, Klein MRST. Impact of Intragastric Balloon Treatment on Adipokines, Cytokines, and Metabolic Profile in Obese Individuals. Obes Surg 2020; 29:2600-2608. [PMID: 31037597 DOI: 10.1007/s11695-019-03891-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Obesity is accompanied by adipose tissue remodeling characterized by increased production of tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, leptin and resistin and reduced secretion of adiponectin, which favors inflammation, metabolic disorders, and cardiovascular diseases. Although intragastric balloon (IGB) can be considered safe and effective for weight loss, its effect on serum levels of these biomarkers has been evaluated only in a few studies, while no previous study evaluated its effect on circulating levels of resistin, TNF-α, and IL-6. The aim of this study was to evaluate the changes in serum levels of metabolic and inflammatory biomarkers in obese patients submitted to IGB treatment. METHODS A prospective observational study involving 42 patients with obesity using IGB for 6 months. The patients were evaluated, on the day of insertion and withdrawal or adjustment of IGB, for the following: anthropometric measures and serum levels of adiponectin, leptin, resistin, TNF-α, IL-6, high-sensitivity C-reactive protein (hs-CRP), glucose, insulin, uric acid, triglycerides, and total cholesterol and fractions. RESULTS The body mass index decreased from 35.15 ± 0.41 to 29.50 ± 0.54 kg/m2. There was a reduction (p < 0.05) in leptin, hs-CRP, glucose, insulin, HOMA-IR, and triglycerides, while the adiponectin/leptin ratio increased (p < 0.05). Moreover, weight loss presented (1) a positive association with the decrease in leptin, hs-CRP, glucose, insulin, HOMA-IR, uric acid, and total cholesterol and (2) a negative association with the reduction in adiponectin/leptin ratio. CONCLUSIONS The present study suggests that 6 months of IGB treatment in obese individuals reduce serum leptin and hs-CRP and improves insulin resistance and lipid profile which may decrease cardiovascular risk.
Collapse
Affiliation(s)
- Marcella Rodrigues Guedes
- Division of Gastroenterology EndogastroRio Clinic, 43/1101, Siqueira Campos Street, Rio de Janeiro, RJ, 22031-901, Brazil.,Post Graduation Program in Clinical and Experimental Pathophysiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Cristina Fajardo Diestel
- Department of Applied Nutrition, Nutrition Institute, Rio de Janeiro State University, 12th floor/524, São Francisco Xavier Street, Rio de Janeiro, RJ, 20550-900, Brazil
| | - Márcia Regina Simas Torres Klein
- Department of Applied Nutrition, Nutrition Institute, Rio de Janeiro State University, 12th floor/524, São Francisco Xavier Street, Rio de Janeiro, RJ, 20550-900, Brazil
| |
Collapse
|
14
|
Gollisch KSC, Raddatz D. Endoscopic intragastric balloon: a gimmick or a viable option for obesity? ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:S8. [PMID: 32309412 PMCID: PMC7154325 DOI: 10.21037/atm.2019.09.67] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Worldwide, the prevalence of obesity has doubled since 1980 in 70 countries. More than one in three adults now suffer from overweight or obesity. Health problems related to obesity include orthopedic problems, psychiatric conditions, metabolic and cardiovascular diseases, and of increasing concern, cancer. Thus, obesity has an enormous impact on the individual’s wellbeing as well as on society’s workforce and health care expenses. Medical efforts are ongoing to find safe and effective treatment options for obesity and its metabolic implications. At present, available treatment options include lifestyle interventions, pharmacotherapy, endoscopic applications, and bariatric surgery. Within the range of endoscopic treatment options, the intragastric balloon is the most widely used device. The idea is simple: the gastric volume is reduced by a balloon that is in most cases implanted by an endoscopic procedure similar to a gastroscopy. During the past decades, different models have been developed, which we will briefly introduce in this review. We aim at reviewing the pathophysiology underlying the effect of endoscopic intragastric balloon on weight loss and metabolic changes. We will assess expected short-term and long-term benefits for the patient, and we will discuss common side effects as well as rare complications. We will compare endoscopic intragastric balloon to conservative treatment options with or without pharmacological support on the one hand and to the spectrum of bariatric surgery on the other hand. In most patients, obesity must be considered a chronic disease that requires a lifelong treatment concept. In view of current treatment options for obesity, we will discuss whether endoscopic intragastric balloon is a viable treatment option, and who may be the right patient to benefit from it.
Collapse
Affiliation(s)
- Katja Susanne Claudia Gollisch
- Department of Gastroenterology and Gastrointestinal Oncology, Endocrine Unit, University Medical Center Göttingen, Göttingen, Germany
| | - Dirk Raddatz
- Department of Gastroenterology and Gastrointestinal Oncology, Endocrine Unit, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
15
|
Real Life Changes in Physical Activity Due to Intragastric Balloon Therapy and Their Relationship to Improving Cognitive Functions: Preliminary Findings. Obes Surg 2020; 30:2821-2825. [PMID: 32020503 PMCID: PMC7260269 DOI: 10.1007/s11695-020-04440-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background We evaluated if the intragastric balloon (IGB) treatment leads to the increase in physical activity (PA) and whether they are related to cognitive improvements. Methods Fourteen morbidly obese patients (151 ± 24 kg, BMI = 51.8 ± 6.5, 107 ± 26% excess weight, 43.3 ± 10.6 years) underwent 6-day-long, uninterrupted evaluations of PA 1 month before IGB insertion and 1 month after its removal. Results Active energy expenditure and physical activity duration increased by more than 80% (p < 0.001) whereas the number of steps per day by 20% (p = 0.016). There was a pattern of relationships between cognitive improvements and increases in PA (p < 0.05). In particular, working memory improvements correlated with the increase in time spent on light physical activities (r = 0.673, p = 0.004). Conclusion The relationships suggest that an increase in physical activity mediates cognitive improvements in bariatric patients.
Collapse
|
16
|
Changes in resting metabolic rate and body composition due to intragastric balloon therapy. Surg Obes Relat Dis 2019; 16:34-39. [PMID: 31734068 DOI: 10.1016/j.soard.2019.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/12/2019] [Accepted: 10/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intragastric balloon (IGB) insertion leads to dietary restriction; however, its neurohormonal actions were also described. Resting metabolic rate (RMR) adjusted for body mass (RMR/mass) seems to increase after bariatric interventions, whereas it generally decreases after caloric restriction-based therapies. However, no studies have evaluated the changes in body composition and RMR over IGB treatment. OBJECTIVE To evaluate the relationships between changes in body composition, RMR, RMR/mass, and RMR adjusted for fat-free mass (FFM) (RMR/FFM) over IGB treatment lasting 6 months. SETTING Single-center observational study. METHODS Twenty-one morbidly obese patients treated with IGB (143 ± 20 kg, body mass index [BMI] = 49.5 ± 7.3, 98% ± 29% percent excess weight, 43.6 ± 12.6 yr) were enrolled. Changes in body composition, RMR, RMR/mass, and RMR/FFM were evaluated between 1 month before IGB insertion (time point 1 [TP1]) and 3 months thereafter (TP2). Fourteen patients were also assessed 1 month after IGB removal (TP3). RESULTS There was a 9.5% reduction in weight, a 9.4% reduction in BMI, and 19.1% decrease in percent excess weight at TP2 (n = 21; P < .001); a further 6.5% reduction in weight and BMI and a 13.1% drop in percent excess weight (n = 14, P < .001) at TP3. They were accompanied by a 5.4% reduction in FFM between TP1 and TP2 (n = 21, P < .001). Compared with pretreatment values, at TP2 RMR was 12.5% lower (P < .001) but did not change thereafter. RMR/mass increased 12.4% between TP2 and TP3 (n = 14, P = .02) but on average did not change between TP1 and TP3. The results in the smaller cohort (n = 14) between TP1 and TP2 were consistent with results obtained for the entire cohort. Similar findings were obtained for RMR/FFM. The larger increases in RMR/mass between TP1 and TP3 were associated with more weight loss, larger drop in BMI, and more loss of excess weight (r < -.55, P < .03). CONCLUSION This is the first study to evaluate the relationship between changes in body composition and RMR over IGB treatment. IGB therapy leads to both fat and fat-free mass reductions and RMR decreases. More weight reduction is associated with larger increases in RMR/mass.
Collapse
|
17
|
Espinet Coll E, López-Nava Breviere G, Nebreda Durán J, Marra-López Valenciano C, Turró Arau R, Esteban López-Jamar JM, Muñoz-Navas M. Spanish consensus document on bariatric endoscopy. Part 2: specific endoscopic treatments. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:140-154. [PMID: 30654612 DOI: 10.17235/reed.2019.4922/2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
During the last years we have been witnessing a significant increase in the number and type of bariatric endoscopic techniques: we have different types of balloons, suture systems, injection of substances and malabsorptive prosthesis, etc. Also, some endoscopic revisional procedures for patients with weight regain after bariatric surgery have been incorporated. This makes it necessary to protocolize, position and regularize all these techniques, through a consensus that allows their clinical application with the maximum medical rigor and scientific evidence available.
Collapse
|
18
|
Choi SJ, Choi HS. Various Intragastric Balloons Under Clinical Investigation. Clin Endosc 2018; 51:407-415. [PMID: 30257544 PMCID: PMC6182294 DOI: 10.5946/ce.2018.140] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/17/2018] [Accepted: 09/17/2018] [Indexed: 12/21/2022] Open
Abstract
Obesity is a chronic disease with an exponentially increasing incidence rate, and its negative effects are well documented in numerous studies. As a result, the importance of bariatric therapy cannot be overemphasized, and many bariatric treatment methods with varying mechanisms have been developed. Of the available treatment methods, intragastric balloons, introduced in the 1980s, have been shown to be a safe and effective treatment modality; various intragastric balloon products have been developed and are currently being widely used in clinical settings. However, the disadvantages of intragastric balloons, such as unclear long-term weight loss benefits and complications experienced during insertion and removal, preclude their wider use. In this review, we discuss different intragastric balloon products, focusing on those under clinical investigation, and suggest future research directions.
Collapse
Affiliation(s)
- Seong Ji Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
19
|
Gazdzinski SP, Gaździńska AP, Orzeł J, Redlisz-Redlicki G, Pietruszka M, Mojkowska A, Pacho RA, Wylezol M. Intragastric balloon therapy leads to normalization of brain magnetic resonance spectroscopic markers of diabetes in morbidly obese patients. NMR IN BIOMEDICINE 2018; 31:e3957. [PMID: 30011110 DOI: 10.1002/nbm.3957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 05/11/2018] [Accepted: 05/16/2018] [Indexed: 06/08/2023]
Abstract
Elevated brain myo-inositol (m-Ins) concentration (a putative marker of neuroinflammation) has been reported in patients suffering from type 2 diabetes mellitus (T2DM). Obesity alone and T2DM have been found to be associated with a lower concentration of N-acetyloaspartate and N-acetylaspartylglutamate (tNAA, a marker of neuronal integrity, reflecting neuronal loss or metabolic derangement). It is not clear if these changes reverse with weight loss. The intra-gastric balloon (IGB) is an endoscopic bariatric therapy that leads to massive weight loss and improvement of glycemic control. In this study we evaluated if tNAA/tCr and m-Ins/tCr metabolite ratios are affected by weight loss, where tCr is the signal of creatine containing compounds. Twenty-three morbidly obese patients, 12 of them with T2DM (OD) and 11 without T2DM (OB), as well as 11 healthy controls of normal weight (CON), underwent single voxel spectroscopy at 3 T. Spectra were obtained within a region in the left parietal white matter one month before IGB insertion, three months after IGB insertion, and one month after IGB removal. Before IGB insertion, m-Ins/tCr was 15% higher in OD than in OB (p = 0.005) and 12% higher in OD than in CON (p = 0.03). m-Ins/tCr decreased significantly by 8% over the first three months after IGB insertion (p = 0.01) and remained normal after IGB removal. tNAA/tCr was normal in all groups throughout the study, pointing to normal brain metabolism. Normalization of m-Ins/tCr is consistent with remission of neuroinflammation in patients with T2DM. An evaluation of long-term effects of IGB treatment is necessary.
Collapse
Affiliation(s)
| | - Agata P Gaździńska
- Department of Nutrition and Obesity, Military Institute of Aviation Medicine, Warsaw, Poland
| | - Jarosław Orzeł
- Department of Radioelectronics, Warsaw University of Technology, Warsaw, Poland
| | | | - Maciej Pietruszka
- Department of Surgery, Military Institute of Aviation Medicine, Warsaw, Poland
| | | | - Ryszard A Pacho
- Department of Radiology, Military Institute of Aviation Medicine, Warsaw, Poland
| | - Mariusz Wylezol
- Department of Surgery, Military Institute of Aviation Medicine, Warsaw, Poland
| |
Collapse
|
20
|
Fink JM, Martini V, Seifert G, Marjanovic G. Left Gastric Artery Embolization for Weight Loss-a Dead-End Procedure. Obes Surg 2018; 28:3623-3624. [PMID: 30043145 DOI: 10.1007/s11695-018-3427-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jodok M Fink
- Center for Surgery, Department of General and Visceral Surgery, Center for Bariatric and Metabolic Surgery, Medical Center - University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
| | - Verena Martini
- Center for Surgery, Department of General and Visceral Surgery, Center for Bariatric and Metabolic Surgery, Medical Center - University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Gabriel Seifert
- Center for Surgery, Department of General and Visceral Surgery, Center for Bariatric and Metabolic Surgery, Medical Center - University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Goran Marjanovic
- Center for Surgery, Department of General and Visceral Surgery, Center for Bariatric and Metabolic Surgery, Medical Center - University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| |
Collapse
|
21
|
Kool N, Müggler SA. Gastric outlet obstruction: a rare complication in patients with intragastric balloon treatment for obesity. BMJ Case Rep 2018; 2018:bcr-2018-224394. [PMID: 29735502 DOI: 10.1136/bcr-2018-224394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Nicoline Kool
- Department of Internal Medicine, Zollikerberg Hospital, Zollikerberg, Switzerland
| | - Simon Andreas Müggler
- Department of Internal Medicine, Zollikerberg Hospital, Zollikerberg, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| |
Collapse
|
22
|
Alsabah S, Al Haddad E, Ekrouf S, Almulla A, Al-Subaie S, Al Kendari M. The safety and efficacy of the procedureless intragastric balloon. Surg Obes Relat Dis 2018; 14:311-317. [DOI: 10.1016/j.soard.2017.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 11/07/2017] [Accepted: 12/01/2017] [Indexed: 12/14/2022]
|
23
|
Filling the Void: A Review of Intragastric Balloons for Obesity. Dig Dis Sci 2017; 62:1399-1408. [PMID: 28421456 DOI: 10.1007/s10620-017-4566-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 04/01/2017] [Indexed: 12/17/2022]
Abstract
Endoscopic bariatric therapies are predicted to become much more widely used in North America for obese patients who are not candidates for bariatric surgery. Of all the endoscopic bariatric therapies, intragastric balloons (IGBs) have the greatest amount of clinical experience and published data supporting their use. Three IGBs are FDA approved and are now commercially available in the USA (Orbera, ReShape Duo, and Obalon) with others likely soon to follow. They are generally indicated for patients whose BMI ranges from 30 to 40 mg/kg2 and who have failed to lose weight with diet and exercise. IGBs have been shown to be safe, effective, and relatively straightforward to place and remove. Accommodative symptoms commonly occur within the initial weeks post-placement; however, major complications are rare. Gastric ulceration can occur in up to 10% of patients, while balloon deflation with migration and bowel obstruction occurs in <1% of patients. The effectiveness of the Orbera and ReShape Duo IGBs ranges from 25 to 50% EWL (excess weight loss) after 6 months of therapy. The use of IGBs is likely to grow dramatically in the USA, and gastroenterologists and endoscopists should be familiar with their indications/contraindications, efficacy, placement/removal, and complications.
Collapse
|
24
|
Almeghaiseeb ES, Ashraf MF, Alamro RA, Almasoud AO, Alrobayan AA. Efficacy of intragastric balloon on weight reduction: Saudi perspective. World J Clin Cases 2017; 5:140-147. [PMID: 28470006 PMCID: PMC5395982 DOI: 10.12998/wjcc.v5.i4.140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/01/2016] [Accepted: 01/02/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate the safety and efficacy of intragastric balloon (IGB) in weight reduction in obese patients referred to a tertiary hospital in the Kingdom of Saudi Arabia. METHODS Three hundred and one consecutive obese individuals, who underwent IGB placement during January 2009 to May 2015, were analyzed. The subjects aged 18 to 60 years and had a minimum body mass index (BMI) of 27 kg/m2. The IGB was placed under conscious sedation and kept for 6 mo. Anthropometric measurements were recorded during and after 6 mo of IGB removal. RESULTS The body weight, excess body weight, and BMI were significantly reduced at the time of IGB removal and 6 mo later. Body weight loss > 10% was achieved in 224 subjects at removal of IGB. End of treatment success and long-term success were both significantly observed in women (70 vs 11) (71 vs 12.5) respectively. Excess BMI loss was significantly higher in subjects retaining the IGB for over 6 mo both at the removal [43.44 ± 19.46 (n = 221) vs 55.60 ± 28.69 (n = 80); t = 4.19, P = 0.0001] as well as at the end of 6 mo' follow-up [46.57 ± 24.89 (n = 221) vs 63.52 ± 31.08 (n = 80); t = 4.87, P = 0.0001]. Within 3 d of IGB placement, two subjects developed pancreatitis and one subject developed cardiac arrhythmia. Intestinal obstruction due to displacement of IGB occurred in two subjects. All these subjects recovered uneventfully after immediate removal of the IGB. CONCLUSION IGB was effective in our cohorts. The observed weight reduction was maintained for at least 6 mo post IGB removal. IGB placement was safe with a satisfactory tolerance rate.
Collapse
|
25
|
Sivero L, Galloro G, Ruggiero S, Alessandro Telesca D, Russo T, Amato M, Di Palma I, Iovino S, Amato B, Sivero S, Forestieri P. Morbid Obesity: treatment with Bioenterics Intragastric Balloon (BIB), psychological and nursing care: our experience. Open Med (Wars) 2017; 11:407-412. [PMID: 28352828 PMCID: PMC5329860 DOI: 10.1515/med-2016-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/24/2016] [Indexed: 11/24/2022] Open
Abstract
Obesity is considered a chronic disease, difficult to treat, and is the first cause of death in the world that is predictable. The surgical approach is limited to patients with severe obesity but there is an intermediate group who are not candidates for immediate surgery. The BioEnterics Intragastric Balloon (BIB) is recommended for weight reduction as a bridge to bariatric surgery. All patients in the study underwent a psychological evaluation prior to placement of the BIB.
Collapse
Affiliation(s)
- Luigi Sivero
- Department of Advanced Biomedical Sciences, University of Naples Federico II - School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Giuseppe Galloro
- Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine. Naples, Italy
| | - Simona Ruggiero
- Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine. Naples, Italy
| | - Donato Alessandro Telesca
- Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine. Naples, Italy
| | - Teresa Russo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine. Naples, Italy
| | - Maurizio Amato
- Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine. Naples, Italy
| | - Immacolata Di Palma
- Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine. Naples, Italy
| | - Speranza Iovino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine. Naples, Italy
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine. Naples, Italy
| | - Stefania Sivero
- Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine. Naples, Italy
| | - Pietro Forestieri
- Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine. Naples, Italy
| |
Collapse
|
26
|
Klobucar Majanovic S, Brozovic B, Stimac D. Bariatric endoscopy: current state of the art, emerging technologies, and challenges. Expert Rev Med Devices 2017; 14:149-159. [PMID: 28081657 DOI: 10.1080/17434440.2017.1281741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Over the last few decades obesity has become a major health issue worldwide. Although dietary and lifestyle changes are the cornerstone of obesity management, it still poses a huge challenge for the majority of patients to permanently change their eating habits. Bariatric endoscopy represents an evolving filed of minimally invasive techniques and procedures for weight loss trying to respond to these challenges by developing new methods with the increasing role of endoscopists in the management of obesity. Areas covered: The aim of this article is to review the role and the advantages of bariatric endoscopy in the management of obesity by providing a comprehensive reference source and evaluating the currently available and emerging endoscopic devices and techniques for weight loss. Expert commentary: Endoscopic methods for weight loss represent a useful armamentarium in the management of obesity by providing improved effectiveness compared with medications, with a lower risk profile than traditional bariatric surgery. Although preliminary results of recently introduced methods are encouraging, many questions remain regarding the safety and efficacy of such interventions. Combining scientific background with advancements in technology is the key strategy for the further development of bariatric endoscopy.
Collapse
Affiliation(s)
- Sanja Klobucar Majanovic
- a Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolic Diseases , University Hospital Rijeka , Croatia , Rijeka
| | - Boris Brozovic
- b Department of Internal Medicine, Division of Gastroenterology , University Hospital Rijeka , Croatia , Rijeka
| | - Davor Stimac
- b Department of Internal Medicine, Division of Gastroenterology , University Hospital Rijeka , Croatia , Rijeka
| |
Collapse
|
27
|
Short-term outcomes of the new intragastric balloon End-Ball ® for treatment of obesity. Wideochir Inne Tech Maloinwazyjne 2016; 11:229-235. [PMID: 28194241 PMCID: PMC5299079 DOI: 10.5114/wiitm.2016.63988] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 10/19/2016] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Intragastric balloons (IGBs) have been successfully used to treat obesity for the last 18 years. These balloons are made of different materials and filled with either air or saline. It seems that balloons filled with saline result in more effective weight loss, but are associated with worse tolerance after implantation. In contrast, balloons filled with air are associated with excellent tolerance, but result in less effective weight loss. AIM To report the early safety and effectiveness results of the End-Ball® balloon and to encourage discussions on how to best use this new-generation IGB for endoscopic weight loss management. MATERIAL AND METHODS Twenty obese patients (mean age: 40.5 years; mean body mass index: 34.8 kg/m2) were included in a 6-month study. Balloons were inflated with 300 ml of saline containing 5 ml of methylene blue and 300 cm3 of air. RESULTS No serious adverse events occurred during treatment. Patients experienced varying degrees of nausea, vomiting (mean: 3.7 times the first day), and abdominal pain after implantation. Six months (23-29 weeks) after End-Ball® balloon insertion, we observed a significant decrease in body weight (13.9 ±5.1 kg) and percent excess weight loss (37.9 ±12.9%). We also found a significant decrease in the levels of glycated hemoglobin (p < 0.001), C-peptide (p < 0.002), and triacylglycerols (p < 0.001) and an increase in the concentration of high-density lipoprotein cholesterol (p < 0.025). CONCLUSIONS The End-Ball® IGB is a safe and effective treatment for morbid obesity, with positive effects on weight loss and saccharide metabolism.
Collapse
|
28
|
Machytka E, Chuttani R, Bojkova M, Kupka T, Buzga M, Stecco K, Levy S, Gaur S. Elipse™, a Procedureless Gastric Balloon for Weight Loss: a Proof-of-Concept Pilot Study. Obes Surg 2016; 26:512-6. [PMID: 26253980 DOI: 10.1007/s11695-015-1783-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Endoscopic gastric balloons have been used effectively as weight loss devices for decades, but the requirement for endoscopy and sedation poses several limitations. The goal of this pilot study was to evaluate the safety and performance of a prototype version of Elipse™, a procedureless gastric balloon. METHODS Eight patients (mean BMI = 31.0 kg/m(2)) participated in this study. Each patient swallowed one Elipse™ balloon intended to remain in the stomach for 6 weeks, self-empty, and then pass. Each balloon was filled with 450 mL of filling fluid. Patients returned every 2 weeks for abdominal ultrasound. No specific diet or exercise plan was prescribed. RESULTS All eight patients successfully swallowed the device. The most common adverse events were nausea and vomiting. There were no serious adverse events, and all balloons were excreted safely. Despite not being prescribed a diet or exercise plan, all eight patients lost weight. In 6/8 patients, the balloon remained full through 6 weeks, self-emptied, and passed. In one patient, the balloon appeared partially collapsed on ultrasound after 11 days and was endoscopically punctured. One asymptomatic patient elected to have the balloon endoscopically punctured after 19 days. Both balloons passed in the stool after 4 days. In both cases, endoscopic examination of the upper GI tract showed no abnormalities. CONCLUSIONS This pilot study demonstrates the safety and performance of Elipse™, a procedureless gastric balloon for weight loss. Future studies will test a commercial design filled to 550 mL intended to last in the stomach for at least 12 weeks.
Collapse
Affiliation(s)
- Evzen Machytka
- Internal Clinic, Department of Gastroenterology, University Hospital Ostrava, Ostrava, Czech Republic. .,Faculty of Medicine, University of Ostrava, 17. Listopadu 1790, Ostrava, 70800, Czech Republic.
| | - Ram Chuttani
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Martina Bojkova
- Internal Clinic, Department of Gastroenterology, University Hospital Ostrava, Ostrava, Czech Republic. .,Faculty of Medicine, University of Ostrava, 17. Listopadu 1790, Ostrava, 70800, Czech Republic.
| | - Tomas Kupka
- Internal Clinic, Department of Gastroenterology, University Hospital Ostrava, Ostrava, Czech Republic. .,Faculty of Medicine, University of Ostrava, 17. Listopadu 1790, Ostrava, 70800, Czech Republic.
| | - Marek Buzga
- Faculty of Medicine, University of Ostrava, 17. Listopadu 1790, Ostrava, 70800, Czech Republic.
| | | | | | | |
Collapse
|
29
|
Štimac D, Klobučar Majanović S, Ličina M. Recent Trends in Endoscopic Management of Obesity. Surg Innov 2016; 23:525-537. [DOI: 10.1177/1553350616643615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Obesity remains a tremendous public health, clinical, and scientific challenge globally. Conventional approaches in the management of obesity offer limited potential for sustained weight loss. Bariatric surgery, although it represents the most effective weight loss treatment, has its own risks and is associated with substantial costs and limited patient applicability. Endoscopic weight loss procedures are considered as the major breakthrough in the management of obesity. Endoluminal interventions performed entirely through the gastrointestinal tract have evolved as a result of an attempt to replicate some of the anatomical features and the physiological effects of the traditional weight loss surgery while being reversible, less invasive, and more cost-effective. Restrictive procedures act to decrease gastric volume by space-occupying devices and/or by suturing or stapling techniques that alter gastric anatomy, whereas malabsorptive procedures tend to create malabsorption by preventing food contact with the duodenum and proximal jejunum. Other procedures act by influencing gastric function (gastric botulinum injections, gastric pacing, and vagal nerve blocking) or by gastric aspiration. It is important to underline that the majority of endoscopic weight loss procedures are still being evaluated and are not yet available routinely. Even though some of the techniques and devices that have recently emerged have demonstrated promising short-term results, evidence on their safety and long-term efficacy from well-designed and well-conducted research should be given before they can become an inherent part of everyday clinical practice. Given the rapid development of endoscopic weight loss procedures, this review considers the current state and recent trends in endoscopic management of obesity.
Collapse
|
30
|
Gavrieli A, Mantzoros CS. Novel Molecules Regulating Energy Homeostasis: Physiology and Regulation by Macronutrient Intake and Weight Loss. Endocrinol Metab (Seoul) 2016; 31:361-372. [PMID: 27469065 PMCID: PMC5053046 DOI: 10.3803/enm.2016.31.3.361] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 06/29/2016] [Accepted: 07/07/2016] [Indexed: 12/13/2022] Open
Abstract
Excess energy intake, without a compensatory increase of energy expenditure, leads to obesity. Several molecules are involved in energy homeostasis regulation and new ones are being discovered constantly. Appetite regulating hormones such as ghrelin, peptide tyrosine-tyrosine and amylin or incretins such as the gastric inhibitory polypeptide have been studied extensively while other molecules such as fibroblast growth factor 21, chemerin, irisin, secreted frizzle-related protein-4, total bile acids, and heme oxygenase-1 have been linked to energy homeostasis regulation more recently and the specific role of each one of them has not been fully elucidated. This mini review focuses on the above mentioned molecules and discusses them in relation to their regulation by the macronutrient composition of the diet as well as diet-induced weight loss.
Collapse
Affiliation(s)
- Anna Gavrieli
- Department of Endocrinology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Christos S Mantzoros
- Department of Endocrinology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
31
|
Kim SH, Chun HJ, Choi HS, Kim ES, Keum B, Jeen YT. Current status of intragastric balloon for obesity treatment. World J Gastroenterol 2016; 22:5495-5504. [PMID: 27350727 PMCID: PMC4917609 DOI: 10.3748/wjg.v22.i24.5495] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 04/28/2016] [Accepted: 05/23/2016] [Indexed: 02/06/2023] Open
Abstract
Endoscopic bariatric therapy may be a useful alternative to pharmacological treatment for obesity, and it provides greater efficacy with lower risks than do conventional surgical procedures. Among the various endoscopic treatments for obesity, the intragastric balloon is associated with significant efficacy in body weight reduction and relief of comorbid disease symptoms. Anatomically, this treatment is based on gastric space-occupying effects that increase the feeling of satiety and may also affect gut neuroendocrine signaling. The simplicity of the intragastric balloon procedure may account for its widespread role in obesity treatment and its applicability to various degrees of obesity. However, advances in device properties and procedural techniques are still needed in order to improve its safety and cost-effectiveness. Furthermore, verification of the physiological outcomes of intragastric balloon treatment and the clinical predictive factors for treatment responses should be considered. In this article, we discuss the types, efficacy, safety, and future directions of intragastric balloon treatment.
Collapse
|
32
|
BioEnterics Intragastric Balloon (BIB) versus Spatz Adjustable Balloon System (ABS): Our experience in the elderly. Int J Surg 2016; 38:138-140. [PMID: 27353844 DOI: 10.1016/j.ijsu.2016.06.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The BioEnterics Intragastric Balloon (BIB) and the Spatz Adjustable Balloon System (ABS) are in fact recommended for weight reduction as a bridge to bariatric surgery. We retrospected studied patients with body mass index (BMI) and age ranges of 37-46 and 70-80 years, respectively, who had undergone BIB from January 2010 to July 2012 and prospected studied patients who had undergone Spatz balloon from July 2012 to August 2014. The aim of this study is to compare BIB and Spatz in terms of weight loss, complications, and maintenance of weight after removal. For both procedures, the median weight loss was 20 ± 3 kg, median BMI at the end of the therapy was 32 ± 2, and no severe complication occurred.
Collapse
|
33
|
Guedes EP, Madeira E, Mafort TT, Madeira M, Moreira RO, Mendonça LMC, Godoy-Matos AF, Lopes AJ, Farias MLF. Impact of a 6-month treatment with intragastric balloon on body composition and psychopathological profile in obese individuals with metabolic syndrome. Diabetol Metab Syndr 2016; 8:81. [PMID: 28031749 PMCID: PMC5168847 DOI: 10.1186/s13098-016-0197-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/04/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the effects of a 6-month treatment with intragastric balloon (IGB) on body composition and depressive/anxiety symptoms in obese individuals with metabolic syndrome (MS). METHODS Fifty patients (aged 18-50 years) with obesity and MS were selected for treatment with IGB for 6 months. Body composition was verified with dual-energy X-ray absorptiometry (DXA) at baseline and right after IGB removal. Anxiety/depressive symptoms were assessed with the Beck Depression Inventory (BDI) and the hospital anxiety and depression scale (HADS) at baseline and after 6 months of treatment. RESULTS In total, 39 patients completed the study. After 6 months, there were significant decreases in weight (11.7 ± 9.6 kg, p < 0.0001) and waist circumference (9.3 ± 8.2 cm, p < 0.0001). Weight loss was also demonstrated by DXA and corresponded to decreases of 3.0 ± 3.4% in body fat percentage, 7.53 ± 7.62 kg in total body fat, and 3.70 ± 4.89 kg in lean body mass (p < 0.001 for all comparisons). Depressive symptoms scores decreased by a mean of 4.57 ± 10.6 points when assessed with the BDI (p = 0.002) and 1.82 ± 5.16 points when assessed with the HADS-Depression (p = 0.0345). Anxiety symptoms scores decreased by a mean of 1.84 ± 4.04 points when determined with the HADS-anxiety (p = 0.0066). The decrease in body fat percentage was the parameter that best correlated with improvements in depressive (p = 0.008) and anxiety symptoms (p = 0.014). CONCLUSIONS In obese individuals with MS, fat mass reduction was associated with short-term improvements in depressive and anxiety symptoms. Trial Registration Registered at ClinicalTrials.gov, NCT01598233.
Collapse
Affiliation(s)
- Erika P. Guedes
- Division of Metabology, State Institute of Diabetes and Endocrinology (IEDE), Rua Moncorvo Filho 90-Centro, Rio de Janeiro, RJ CEP 20211-340 Brazil
- Division of Endocrinology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eduardo Madeira
- Division of Endocrinology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Division of Gastroenterology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thiago T. Mafort
- Division of Pulmonology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Miguel Madeira
- Division of Endocrinology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodrigo O. Moreira
- Division of Metabology, State Institute of Diabetes and Endocrinology (IEDE), Rua Moncorvo Filho 90-Centro, Rio de Janeiro, RJ CEP 20211-340 Brazil
- Division of Endocrinology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Amélio F. Godoy-Matos
- Division of Metabology, State Institute of Diabetes and Endocrinology (IEDE), Rua Moncorvo Filho 90-Centro, Rio de Janeiro, RJ CEP 20211-340 Brazil
| | - Agnaldo J. Lopes
- Division of Pulmonology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Lucia F. Farias
- Division of Endocrinology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
34
|
Ibarra-Reynoso LDR, Pisarchyk L, Pérez-Luque EL, Garay-Sevilla ME, Malacara JM. Dietary restriction in obese children and its relation with eating behavior, fibroblast growth factor 21 and leptin: a prospective clinical intervention study. Nutr Metab (Lond) 2015; 12:31. [PMID: 26379757 PMCID: PMC4570615 DOI: 10.1186/s12986-015-0027-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/31/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity is significant problem involving eating behavior and peripheral metabolic conditions. The effect of carbohydrate and fat restriction on appetite regulation, fibroblast growth factor 21 (FGF21) and leptin in children has not been defined. Our objective was to compare the effect of both diets. METHODS One hundred and twenty children with body mass index (BMI) higher than the equivalent of 30 kg/m(2) for an adult, as corrected for gender and age were randomly assigned to (n = 60) a low-carbohydrate (L-CHO) diet or (n = 60) a low-fat (L-F) diet for 2 months. Fifty-three (88.3 %) subjects on the low-carbohydrate-diet and 45 (75 %) on the low-fat diet completed the study. Anthropometric measures, leptin and FGF21 levels were measured before and after the intervention. Comparison of the data for both of the diet groups was carried out using the t-test for independent variables. Intragroup comparisons before and after of each of the dietary treatments were performed using ANOVA for repeated measures. Factors associated with FGF21, leptin levels and satiety, were analyzed by multiple regression. RESULTS After both of the diets, weight, leptin, food responsiveness, and enjoyment of food significantly decreased and high density lipoprotein cholesterol (HDL) increased, but FGF21 decreased. Before and after both of the interventions FGF21 was associated with triglycerides. Before the diet, satiety was associated with lower screen time (p < 0.04) and insulin levels (p < 0.05). CONCLUSIONS Both dietary restrictions improved the metabolic and hormonal parameters of obese children. FGF21 is an indicator of a beneficial metabolic response in younger children. After 2 months an adaptation of the eating behavior to food restriction was observed.
Collapse
Affiliation(s)
| | - Liudmila Pisarchyk
- Department of Medical Sciences, University of Guanajuato, Campus León. 20 de Enero 929. Col Obregón, León Gto, México 37320
| | - Elva Leticia Pérez-Luque
- Department of Medical Sciences, University of Guanajuato, Campus León. 20 de Enero 929. Col Obregón, León Gto, México 37320
| | - Ma Eugenia Garay-Sevilla
- Department of Medical Sciences, University of Guanajuato, Campus León. 20 de Enero 929. Col Obregón, León Gto, México 37320
| | - Juan Manuel Malacara
- Department of Medical Sciences, University of Guanajuato, Campus León. 20 de Enero 929. Col Obregón, León Gto, México 37320
| |
Collapse
|
35
|
Laparoscopic gastric plication and its effect on saccharide and lipid metabolism: a 12-month prospective study. Wideochir Inne Tech Maloinwazyjne 2015; 10:398-405. [PMID: 26649086 PMCID: PMC4653266 DOI: 10.5114/wiitm.2015.54103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 08/09/2015] [Accepted: 08/19/2015] [Indexed: 12/31/2022] Open
Abstract
Introduction Laparoscopic greater curvature plication (LGCP) is a novel restrictive technique that reduces gastric volume by plication of the greater curvature. The advantage of LGCP is its reversibility in comparison to laparoscopic sleeve gastrectomy. Nowadays, the long-term LGCP efficacy, safety and metabolic effect are being investigated. Aim To assess body composition, clinical complications and metabolic changes in obese patients 6 and 12 months after laparoscopic greater curvature plication. Material and methods A total of 70 subjects underwent LGCP; 52 of them (33 women and 19 men) completed 1-year follow-up study. Anthropometry and biochemical parameters (glucose, glycated haemoglobin, lipids, ghrelin, leptin, adiponectin and fibroblast growth factor 21 [FGF-21]) were assessed before and 3, 6, and 12 months after surgery. Results All study participants exhibited statistically significant weight loss at both 6 and 12 months following the LGCP compared to baseline, with significant reductions in body composition – body weight, body mass index, percentage excess weight loss (%EWL), and percentage excess BMI loss (%EBL) (p ≤ 0.001). Moreover, significant lowering of glucose and glycated haemoglobin, triacylglycerols and leptin was observed 12 months after LGCP. On the other hand, plasma concentrations of ghrelin, adiponectin and LDL cholesterol increased significantly. Total cholesterol, LDL cholesterol and FGF-21 levels did not change significantly. Conclusions Laparoscopic greater curvature plication appears to be a procedure with good restriction results, which might be mediated through alteration in incretin metabolism. Technical aspects and standardization of the procedure still remain to be worked out.
Collapse
|
36
|
Abstract
Unhealthy diet and lack of physical exercise are responsible for fat accumulation in the liver, which may lead to liver disease. Histologically, the severity of the disease has two stages: nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). NAFLD is defined by the presence of steatosis with no evidence of cellular injury such as hepatocyte ballooning. NASH is a distinct entity from NAFLD, and is characterized by the presence of inflammation with hepatocytes damage, with or without fibrosis. While several therapeutic strategies have been proposed to improve this condition, the present review aims to discuss nonmedicinal interventions used to reduce liver involvement or to prevent the disease altogether. The authors investigated dietary patterns and vitamin deficiencies associated with NAFLD, and their role in enhancing disease severity. Additionally, they reviewed the role of exercise and the use of interventions, such as as intragastric balloon and bariatric surgery, for improving disease progression. The authors propose monitoring disease progression or repair by following changes in cytoadipokine levels.
Collapse
|