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Abbitt D, Choy K, Kovar A, Jones TS, Wikiel KJ, Jones EL. Weight regain after intragastric balloon for pre-surgical weight loss. World J Gastrointest Surg 2024; 16:2040-2046. [DOI: 10.4240/wjgs.v16.i7.2040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/11/2024] [Accepted: 06/24/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND Over one-third of Americans carry the diagnosis of obesity, many also with obesity-related comorbidities. This can place patients at increased risk of operative and postoperative complications. The intragastric balloon has been shown to aid in minor weight loss, however its weight recidivism in patients requiring short interval weight loss has not been well studied.
AIM To evaluate weight loss, ability to undergo successful elective surgery after intragastric balloon placement, and weight management after balloon removal.
METHODS This study is a retrospective review of patients in a single academic institution undergoing intragastric balloon placement from 2019-2023 to aid in weight loss prior to undergoing elective surgery. Clinical outcomes including weight loss, duration of balloon placement, successful elective surgery, weight regain post-balloon and post-procedure complications were assessed. Exclusion criteria included those with balloon in place at time of study.
RESULTS Thirty-three patients completed intragastric balloon therapy from 2019-2023 as a bridge to elective surgery. All patients were required to participate in a 12-month weight management program to be eligible for balloon therapy. Elective surgeries included incisional hernia repair, umbilical hernia repair, inguinal hernia repair, and knee and hip replacements. The average age at placement was 53 years ± 11 years, majority (91%) were male. The average duration of intragastric balloon therapy was 186 days ± 41 days. The average weight loss was 14.0 kg ± 7.4 kg and with an average percent excess body weight loss of 30.0% (7.9%-73.6%). Over half of the patients (52.0%) achieved the goal of 30-50 lbs (14-22 kg) weight loss. Twenty-one patients (64%) underwent their intended elective surgery, 2 patients (6%) deferred surgery due to symptom relief with weight loss alone. Twenty-one of the patients (64%) have documented weights in 3 months after balloon removal, in these patients the majority (76%) gained weight after balloon removed. In patients with weight regain at 3 months, they averaged 5.8 kg after balloon removal in the first 3 months, this averaged 58.4% weight regain of the initial weight lost.
CONCLUSION Intragastric balloon placement is an option for short-term weight management, as a bridge to elective surgery in patients with body mass index (BMI) > 35. Patients lost an average of 14 kg with the balloon, allowing two-thirds of patients to undergo elective surgery at a healthy BMI. However, most patients regained an average of 58% of the original weight lost after balloon removal. The intragastric balloon successfully serves as a tool for rapid weight loss, though patients must be educated on the risks including weight regain.
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Affiliation(s)
- Danielle Abbitt
- Department of Surgery, University of Colorado, Aurora, CO 80045, United States
| | - Kevin Choy
- Department of Surgery, University of Colorado, Aurora, CO 80045, United States
| | - Alexandra Kovar
- Department of Surgery, University of Colorado, Aurora, CO 80045, United States
| | - Teresa S Jones
- Department of Surgery, University of Colorado, Aurora, CO 80045, United States
- Department of Surgery, Rocky Mountain Regional Veteran Affairs Medical Center, Aurora, CO 80045, United States
| | - Krzysztof J Wikiel
- Department of Surgery, University of Colorado, Aurora, CO 80045, United States
- Department of Surgery, Rocky Mountain Regional Veteran Affairs Medical Center, Aurora, CO 80045, United States
| | - Edward L Jones
- Department of Surgery, University of Colorado, Aurora, CO 80045, United States
- Department of Surgery, Rocky Mountain Regional Veteran Affairs Medical Center, Aurora, CO 80045, United States
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Dejeu D, Dejeu P, Bradea P, Muresan A, Dejeu V. Evaluating Weight Loss Efficacy in Obesity Treatment with Allurion's Ingestible Gastric Balloon: A Retrospective Study Utilizing the Scale App Health Tracker. Clin Pract 2024; 14:765-778. [PMID: 38804393 PMCID: PMC11130893 DOI: 10.3390/clinpract14030061] [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: 03/30/2024] [Revised: 04/18/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Obesity represents a growing public health concern, affecting more than 15% of the global adult population and involving a multi-billion market that comprises nutritional, surgical, psychological, and multidisciplinary interventions. The objective of this retrospective study was to evaluate the short-term efficacy and body weight measurements associated with differing levels of physical activity following the use of Allurion's ingestible gastric balloon that was designed to increase feelings of fullness and decrease food consumption, being naturally eliminated after approximately 16 weeks. This study involved 571 individuals who qualified for the intervention for being older than 20 years with a body mass index (BMI) of 27 kg/m2 or more. Utilizing the Scale App Health Tracker and Allurion's smartwatch, this study was able to track vital signs and physical activity in real time. The participants had an average initial BMI of 34.1 kg/m2 and a median age of 41 years. Notable outcomes were observed in both study groups, "Less Active" and "More Active", which were classified by achieving less or more than a median number of 8000 daily steps. Specifically, body fat percentage saw a reduction from 33.1 ± 9.4 to 28.3 ± 10.2 in the less active group and from 32.2 to 27.5 in the more active group, with both groups achieving statistical significance (p < 0.001). Additionally, there was a significant reduction in average weight, dropping from 98.2 ± 22.8 kg to 84.6 ± 19.3 kg in the less active group and from 97.7 ± 21.0 kg to 82.1 ± 22.9 kg in the more active group (both p < 0.001). Interestingly, those in the more active group also experienced a significant increase in lean mass compared to their less active counterparts (p = 0.045), although no substantial differences in weight loss, BMI reduction, and total body fat decrease were observed between the two groups. This investigation confirms the hypothesis that Allurion's ingestible gastric balloon significantly reduces weight in the short term and enhances several physical health metrics, demonstrating effectiveness as an autonomous method for challenging weight management, regardless of the level of daily physical activity.
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Affiliation(s)
- Danut Dejeu
- Surgical Oncology Department, Emergency County Hospital Oradea, Strada Gheorghe Doja 65, 410169 Oradea, Romania; (D.D.); (A.M.)
- Bariatric Surgery Department, Medlife Humanitas Hospital, Strada Frunzisului 75, 400664 Cluj Napoca, Romania
| | - Paula Dejeu
- Laboratory Medicine Unit, Betania Medical Center, Menumorut 12, 410004 Oradea, Romania
| | - Paula Bradea
- Gastroenterology Unit, Betania Medical Center, Menumorut 12, 410004 Oradea, Romania;
| | - Anita Muresan
- Surgical Oncology Department, Emergency County Hospital Oradea, Strada Gheorghe Doja 65, 410169 Oradea, Romania; (D.D.); (A.M.)
| | - Viorel Dejeu
- Bariatric Surgery Department, Life Memorial Hospital, Calea Grivitei 365, 010719 Bucuresti, Romania;
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Coelho DL, Amaral RC, Silva IC, Oliveira AVOB, Neto AS, Silva JFP, Joviano-Santos JV. Realistic simulation and medical students' performance in the Advanced Cardiac Life Support course: a comparative study. ADVANCES IN PHYSIOLOGY EDUCATION 2024; 48:61-68. [PMID: 37994405 DOI: 10.1152/advan.00113.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023]
Abstract
Clinical practice has benefited from new methodologies such as realistic simulation (RS). RS involves recreating lifelike scenarios to more accurately reflect real clinical practice, enhancing learners' skills and decision-making within controlled environments, and experiencing remarkable growth in medical education. However, RS requires substantial financial investments and infrastructure. Hence, it is essential to determine the effectiveness of RS in the development of skills among medical students, which will improve the allocation of resources while optimizing learning. This cross-sectional study was carried out in the simulation laboratory of a medical school, and the performance of students who underwent two different curriculum matrices (without RS and with RS, from 2021 to 2022) in the Advanced Cardiac Life Support (ACLS) course was compared. This test was chosen considering that the competencies involved in cardiac life support are essential, regardless of the medical specialty, and that ACLS is a set of life-saving protocols used worldwide. We observed that the impact of RS can be different for practical abilities when compared with the theoretical ones. There was no correlation between the general academic performance and students' grades reflecting the RS impact. We conclude that RS leads to less remediation and increased competence in practical skills. RS is an important learning strategy that allows repeating, reviewing, and discussing clinical practices without exposing the patient to risks.NEW & NOTEWORTHY Realistic simulation (RS) positively affected the performance of the students differently; it had more influence on practical abilities than theoretical knowledge. No correlation between the general academic performance and grades of the students without RS or with RS was found, providing evidence that RS is an important tool in Advanced Cardiac Life Support education.
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Affiliation(s)
- Débora L Coelho
- Post-Graduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rosana C Amaral
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Isabella C Silva
- Student of the Course in Medicine, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Virgínia O B Oliveira
- Student of the Course in Medicine, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Augusto Scalabrini Neto
- Post-Graduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - José Felippe P Silva
- Post-Graduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Julliane V Joviano-Santos
- Post-Graduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Laboratório de Investigações NeuroCardíacas, Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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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.
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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
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Alangari A, Alamri M, Semaan T, Hafez I, Alruzug I. Varicocele Secondary to Splenic Vein Compression by Intragastric Balloon. ACG Case Rep J 2023; 10:e01155. [PMID: 37736357 PMCID: PMC10511032 DOI: 10.14309/crj.0000000000001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023] Open
Abstract
Intragastric balloons (IGBs) are commonly used for weight loss by mechanically distending the stomach. We present a case of a 35-year-old man who developed a left-sided varicocele 1 week after IGB insertion. Imaging revealed splenic vein compression and possible thrombosis. Urgent removal of the balloon was performed. After 1 week from removal, the patient showed significant improvement, with complete splenic vein recanalization. This case highlights the importance of early recognition of a rare complication of IGBs to avoid severe outcomes. To our knowledge, this is the first reported case linking IGBs to splenic vein compression and varicocele.
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Affiliation(s)
- Abdulrahman Alangari
- Department of Gastroenterology and Hepatology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
- Department of Gastroenterology and Hepatology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Musab Alamri
- Department of Radiology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Toufic Semaan
- Department of Gastroenterology and Hepatology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ihab Hafez
- Department of Gastroenterology and Hepatology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ibrahim Alruzug
- Department of Gastroenterology and Hepatology, King Saud Medical City, Riyadh, Saudi Arabia
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Foula MS, Amer NM, Zakaria H, Ismail MH, Alshomimi SJ, Al Bisher HM, Alsaleem H, Almulhim K, Aldabaeab AE, Alratrout H, Alsadery HA, Alarfaj MA, Aljehani YM, El Damati AM. Surgical Management of Intra-gastric Balloon Complications, Single-Center Experience, and Literature Review. Obes Surg 2023; 33:2718-2724. [PMID: 37452985 DOI: 10.1007/s11695-023-06716-x] [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: 11/03/2022] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION In Saudi Arabia, the prevalence of obesity has multiplied in the last decades leading to a surge in bariatric surgery and other endoscopic modalities. The intra-gastric balloon (IGB) is the most used endoscopic modality. Surgical management for IGB complications is required for gastrointestinal perforation and/or obstruction. However, the literature seems to underestimate these complications. MATERIALS AND METHODS A retrospective descriptive study was conducted in King Fahd University Hospital, Saudi Arabia, from Jan 2017 to Dec 2021, including all patients with complicated IGB who necessitated any surgical procedure. Exclusion criteria were patients with complicated IGBs that were only managed conservatively or endoscopically. RESULTS A total of 326 patients were admitted with different complications after bariatric procedures. Of them, six patients were referred due to IGB complications that necessitated operative intervention. All patients were young females. Three patients had gastric wall perforation, and were managed by endoscopic removal of the IGBs followed by exploratory laparotomy. One patient had an intestinal obstruction on top of a migrated IGB that was surgically removed. One patient had failed endoscopic retrieval of IGB and required a laparoscopic gastrostomy. Another patient had an esophageal rupture that required left thoracotomy, pleural flap, and insertion of an esophageal stent. All cases were discharged and followed up with no related complications. CONCLUSION IGB is an endoscopic alternative, within specific indications, for the management of obesity. However, surgical management may be necessary to manage its complications, including gastrointestinal perforation, IGB migration, and failure of endoscopic removal.
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Affiliation(s)
- Mohammed S Foula
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia.
| | - Nasser M Amer
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hazem Zakaria
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Mona H Ismail
- Division of Gastroenterology, Department of Internal Medicine, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Saeed J Alshomimi
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hassan M Al Bisher
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hassan Alsaleem
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Khalifa Almulhim
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Abdulaziz E Aldabaeab
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hefzi Alratrout
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Humood A Alsadery
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Mosab A Alarfaj
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Yasser M Aljehani
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Ahmed M El Damati
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Martines G, Dezi A, Giove C, Lantone V, Rotelli MT, Picciariello A, Tomasicchio G. Efficacy of Intragastric Balloon versus Liraglutide as Bridge to Surgery in Super-Obese Patients. Obes Facts 2023; 16:457-464. [PMID: 37579738 PMCID: PMC10601677 DOI: 10.1159/000531459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/23/2023] [Indexed: 08/16/2023] Open
Abstract
INTRODUCTION Bariatric surgery is a safe and effective treatment for obesity, although in super-obese patients (BMI ≥50 kg/m2) it can become challenging for anatomical and anesthesiologic issues. Several bridging therapies have been proposed to increase preoperative weight loss and decrease perioperative morbidity and mortality. The aim of this study was to compare the efficacy and safety of different two-stage approaches in super-obese patients: laparoscopic sleeve gastrectomy (LSG) following preoperative liraglutide therapy versus LSG with preoperative intragastric balloon (IGB) during a 1-year follow-up. METHODS Clinical records of 86 patients affected by super-obesity who underwent two-stage approach between January 2019 and January 2022 were retrospectively reviewed using a prospectively maintained database. Patients were separated into two groups: those managed with preoperative IGB and those with liraglutide 3.0 mg prior to LSG. Weight (kg), BMI (kg/m2), %EWL, and %EBWL were reported and compared between the two groups at the end of bridging therapy, at 6th month and 12th month postoperatively. Postoperative complications were recorded. RESULTS Forty-four patients underwent IGB insertion prior to LSG, while 42 were treated with liraglutide. There were no statistical differences in baseline weight and BMI. At the end of preoperative treatment, the group treated with IGB reported a significant reduction in BMI (47.24 kg/m2 vs. 53.6 kg/m2; p < 0.391) compared to liraglutide group. There were no differences recorded between the two groups concerning postoperative complications. At 6 months, the liraglutide group had lower %EWL (15.8 vs. 29.84; p < 0.05) and %EBWL (27.8 vs. 55.6; p < 0.05) when compared to IGB group. At 12 months, the IGB preserved with higher %EWL (39.9 vs. 25; p < 0.05) and %EBWL (71.2 vs. 42; p < 0.05). CONCLUSION A two-stage therapeutic approach with IGB prior to LSG in super-obese patients could be considered an attractive alternative to liraglutide as bridging therapy before bariatric surgery.
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Affiliation(s)
- Gennaro Martines
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), General Surgery Unit "M. Rubino," University of Bari Aldo Moro, Bari, Italy
| | - Agnese Dezi
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), General Surgery Unit "M. Rubino," University of Bari Aldo Moro, Bari, Italy
| | - Carlo Giove
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), General Surgery Unit "M. Rubino," University of Bari Aldo Moro, Bari, Italy
| | - Valerio Lantone
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), General Surgery Unit "M. Rubino," University of Bari Aldo Moro, Bari, Italy
| | - Maria Tersa Rotelli
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), General Surgery Unit "M. Rubino," University of Bari Aldo Moro, Bari, Italy
| | - Arcangelo Picciariello
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), General Surgery Unit "M. Rubino," University of Bari Aldo Moro, Bari, Italy
| | - Giovanni Tomasicchio
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), General Surgery Unit "M. Rubino," University of Bari Aldo Moro, Bari, Italy
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Tang RC, Yang IH, Lin FH. Current Role and Potential of Polymeric Biomaterials in Clinical Obesity Treatment. Biomacromolecules 2023; 24:3438-3449. [PMID: 37442789 DOI: 10.1021/acs.biomac.3c00388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
The rise of obesity and associated fatal diseases has taken a massive toll worldwide. Despite the existing pharmaceuticals and bariatric surgeries, these approaches manifest limited efficacy or accompany various side effects. Therefore, researchers seek to facilitate the prolonged and specific delivery of therapeutics. Or else, to mimic the essential part of "gastric bypass" by physically blocking excessive absorption via less invasive methods. To achieve these goals, polymeric biomaterials have gained tremendous interest recently. They are known for synthesizing hydrogels, microneedle patches, mucoadhesive coatings, polymer conjugates, and so forth. In this Review, we provide insights into the current studies of polymeric biomaterials in the prevention and treatment of obesity, inspiring future improvements in this regime of study.
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Affiliation(s)
- Rui-Chian Tang
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, No. 35, Keyan Road, Zhunan, Miaoli County 35053, Taiwan
| | - I-Hsuan Yang
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, No. 35, Keyan Road, Zhunan, Miaoli County 35053, Taiwan
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, No. 49, Fanglan Road, Taipei 10672, Taiwan
| | - Feng-Huei Lin
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, No. 35, Keyan Road, Zhunan, Miaoli County 35053, Taiwan
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, No. 49, Fanglan Road, Taipei 10672, Taiwan
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Jerez J, Cabrera D, Cisneros C, Moreno M, Guaitara D, Benavides C, Fors M, Falcon K. INTRAGASTRIC BALLOON AND IMPACT ON WEIGHT LOSS: EXPERIENCE IN QUITO, EQUADOR. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 36:e1731. [PMID: 37255102 DOI: 10.1590/0102-672020230002e1731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/30/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Obesity is associated with different medical conditions, such as cardiologic, respiratory, gastrointestinal, and genitourinary, and constitutes a severe health problem. AIMS This study aimed to evaluate the use of intragastric fluid-filled balloon in the reduction of weight and other measurements related to body composition. METHODS This is a retrospective, monocentric study involving all patients who opted for the intragastric balloon Spatz® placement from January 2018 to July 2019, with fulfillment of inclusion and exclusion criteria. The patients were analyzed after 6 and 12 months after the intragastric fluid-filled balloon placed. RESULTS A total of 121 subjects were included in this study, with 83 (68.6%) females and 38 (31.4%) males. The mean age was 36 years and height was 1.64±0.09. Weight mean and standard deviation was 89.85±14.65 kg, and body mass index was 33.05±4.03; body mass index decreased to 29.4 kg/m2 with a mean weight of 79.83 kg, after 12 months of follow-up. There were statistical differences between body mass index and the 12 months in fat percentage, fat-free mass (kg), visceral fat area, and basal metabolic rate. There was a significant variation according to gender, with males having highest reduction. The percentage of excess weight loss was 46.19, and the total weight loss was 9.24 at the end of the study. CONCLUSIONS The study demonstrated a benefit of intragastric fluid-filled balloon on weight loss after 12 months. At the end of treatment, body mass index and the measurements of body composition were significantly lower. Men benefited more than women from the treatment.
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Affiliation(s)
| | | | | | | | | | | | - Martha Fors
- Universidad de las Américas, Faculty of Health Sciences - Quito, Equador
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Boškoski I, Pontecorvi V, Ibrahim M, Huberty V, Maselli R, Gölder SK, Kral J, Samanta J, Patai ÁV, Haidry R, Hollenbach M, Pérez-Cuadrado-Robles E, Silva M, Messmann H, Tham TC, Bisschops R. Curriculum for bariatric endoscopy and endoscopic treatment of the complications of bariatric surgery: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2023; 55:276-293. [PMID: 36696907 DOI: 10.1055/a-2003-5818] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Obesity is a chronic, relapsing, degenerative, multifactorial disease that is associated with many co-morbidities. The global increasing burden of obesity has led to calls for an urgent need for additional treatment options. Given the rapid expansion of bariatric endoscopy and bariatric surgery across Europe, the European Society of Gastrointestinal Endoscopy (ESGE) has recognized the need to formalize and enhance training in bariatric endoscopy and the endoscopic treatment of bariatric surgical adverse events. This manuscript represents the outcome of a formal Delphi process resulting in an official Position Statement of the ESGE and provides a framework to develop and maintain skills in bariatric endoscopy and the endoscopic treatment of bariatric surgical adverse events. This curriculum is set out in terms of the prerequisites prior to training, minimum number of procedures, the steps for training and quality of training, and how competence should be defined and evidenced before independent practice. 1: ESGE recommends that every endoscopist should have achieved competence in upper gastrointestinal endoscopy before commencing training in bariatric endoscopy and the endoscopic treatment of bariatric surgical adverse events. 2: Trainees in bariatric endoscopy and the endoscopic treatment of the complications of bariatric surgery should have basic knowledge of the definition, classification, and social impact of obesity, its pathophysiology, and its related co-morbidities. The recognition and management of gastrointestinal diseases that are more common in patients with obesity, along with participation in multidisciplinary teams where obese patients are evaluated, are mandatory. 3 : ESGE recommends that competency in bariatric endoscopy and the endoscopic treatment of the complications of bariatric surgery can be learned by attending validated training courses on simulators initially, structured training courses, and then hands-on training in tertiary referral centers.
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Affiliation(s)
- Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Valerio Pontecorvi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mostafa Ibrahim
- Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt
| | - Vincent Huberty
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Roberta Maselli
- Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Stefan K Gölder
- Department of Internal Medicine, Ostalb Klinikum Aalen, Aalen, Germany
| | - Jan Kral
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Árpád V Patai
- Division of Gastroenterology, Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Rehan Haidry
- Department of Gastroenterology, University College London Hospital, London, UK
| | - Marcus Hollenbach
- Medical Department II, Division of Gastroenterology, University of Leipzig Medical Center, Leipzig, Germany
| | | | - Marco Silva
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Helmut Messmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Tony C Tham
- Division of Gastroenterology, Ulster Hospital, Dundonald, Belfast, Northern Ireland
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospital Leuven, TARGID, KU Leuven, Leuven, Belgium
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11
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Bawahab MA, Abbas KS, Maksoud WMAE, Abdelgadir RS, Altumairi K, Alqahtani AR, Alzahrani HA, Bhat MJ. Factors Affecting Weight Reduction after Intragastric Balloon Insertion: A Retrospective Study. Healthcare (Basel) 2023; 11:healthcare11040600. [PMID: 36833134 PMCID: PMC9957044 DOI: 10.3390/healthcare11040600] [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] [Received: 12/27/2022] [Revised: 02/11/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Intragastric balloon (IGB) is a safe option for obesity management. However, studies determining the factors influencing the procedure's outcomes are scarce. Therefore, our goal was to determine the factors affecting weight reduction after IGB insertion. MATERIALS AND METHODS This retrospective study included 126 obese patients who underwent IGB treatment using the ORBERA® Intragastric Balloon System. Patients' records were retrieved; and demographic data, initial body mass index (BMI), complications, compliance with both diet and exercise programs, and percentage of excess weight reduction were recorded. RESULTS The study included 108 female (85.7%) and 18 male (14.3%) patients. The mean age was 31.7 ± 8.1 years. The percentage of excess weight loss (EWL) was 55.8 ± 35.7%. The mean weight loss was 13.01 ± 7.51 kg. A significant association was found between EWL and age, initial weight, initial body mass index, and the number of pregnancies. No major complications were observed. However, the balloon had to be removed early in two patients (1.59%) due to its rupture and in two other patients (1.59%) due to severe gastritis. CONCLUSIONS IGB therapy is a safe and effective option for obesity management, associated with low rates of complications. The EWL after IGB insertion is significantly higher among older patients, those with a relatively low initial body mass index, those with a longer duration of IGB insertion, and female patients with less parity. Larger prospective studies are needed to support our results.
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Affiliation(s)
- Mohammed A. Bawahab
- Surgery Department, Faculty of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia
| | - Khaled S. Abbas
- Surgery Department, Faculty of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia
| | - Walid M. Abd El Maksoud
- Surgery Department, Faculty of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia
- Correspondence: ; Tel.: +966-543128555
| | - Reem S Abdelgadir
- General Surgery, Abha International Private Hospital, Abha 62521, Saudi Arabia
| | | | - Awadh R. Alqahtani
- Surgery Department, Faculty of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Hassan A. Alzahrani
- Surgery Department, Faculty of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia
| | - Muneer Jan Bhat
- Anesthesia, Surgery Department, Faculty of Medicine, King Khalid University, Abha 61421, Saudi Arabia
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12
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Outcomes and Trends of Endoscopic Bariatric Therapies (EBT) Among Minority Populations. Obes Surg 2023; 33:513-522. [PMID: 36477696 DOI: 10.1007/s11695-022-06399-w] [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: 08/07/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Endoscopic bariatric therapies (EBT) have emerged as effective options for weight loss. While the benefits of EBT have been documented, data regarding such therapies among minority populations remains scant. We aim to investigate EBT trends and outcomes in minority populations. METHODS Data were extracted from the 2015 to 2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project (MBSAQIP) databases. Intragastric balloon (IGB) and endoscopic sleeve gastroplasty (ESG) cases were identified, and procedure volume assessed by year and race/ethnicity. Measures of interest included year-to-year mortality, surgical complications, and 30-day adverse outcomes. RESULTS Of 966,646 cases in the MBSAQIP databases, 5209 (0.54%) IGB and ESG cases were included. 10.7% were black, and 81.6% were female patients. Compared to white patients, black and Hispanic patients were younger (p < 0.01) with a higher body mass index (p < 0.001). Mortality (0.03% vs. 0% vs. 0%, p = 0.99), reoperation (1.1% vs. 0.8% vs. 0.6%, p = 0.30), and reintervention (3.9% vs. 3.2% vs. 2.3%, p = 0.09) rates were similar between racial/ethnic cohorts. All complications were similar between racial/ethnic cohorts, except a higher rate of venous thromboembolism, in Hispanic (1.04%, p < 0.01) compared to black (0.18%) and white (0.21%) patients. IGB and ESG were predominantly performed in white and Hispanic patients, respectively. ESG was associated with a higher leak (0.6% vs. 0.02%, p < 0.01) and venous thromboembolism (VTE) (1.0% vs. 0.12%, p < 0.01) rate. CONCLUSION While EBTs have increased annually, they are performed less in black patients. Future studies are needed to identify access barriers for black patients. They are safely performed with similar outcomes in racial/ethnic cohorts, except for a higher VTE rate in Hispanic patients.
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13
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Liu X, Wu Y, Liu C, Chen K, Gregersen H. Development of an Ingestible Expandable Capsule for Weight Loss. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16821. [PMID: 36554702 PMCID: PMC9779746 DOI: 10.3390/ijerph192416821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/04/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
Obesity has grown to epidemic proportions with 2.1 billion people being overweight worldwide. A food-grade expandable capsule named EndoXpand for the treatment of overweight people was designed and developed in this study. EndoXpand consists of an inner expandable material (core), an embracing membrane, and a gelatin capsule shell. It is designed to occupy volume in the stomach and reduce hunger sensation. The occupied volume is changeable over time, dependent on the number of ingested capsules and their degradation time. This will avoid gastric accommodation to constant volume devices as seen in the use of intragastric balloons. Several materials were tested. Collagen casing was selected as the membrane and corn silk was used to tie the membrane. Dried black fungus (Auricularia auricula) was the biological material that expanded most. However, synthesized cellulose-based hydrogel expanded more and was chosen as the optimal expandable core material. The hydrogel-based EndoXpand expanded 72 times after soaking in an acidic environment for 80 min. The corn silk ligations weakened and broke after 3 h. This resulted in release of the expanded material that was designed to easily pass the pylorus and travel down the intestine for digestion or excretion. In conclusion, this study provides design and in vitro proof-of-technology data for a potential groundbreaking approach. Further studies are needed in animal models and human phase I studies.
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Affiliation(s)
- Xingyu Liu
- Graduate School, Chongqing Normal University, Chongqing 401331, China
| | - Yeung Wu
- Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong 999077, China
| | - Chang Liu
- Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong 999077, China
| | - Kaiqi Chen
- Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong 999077, China
| | - Hans Gregersen
- GIOME, California Medical Innovations Institute, San Diego, CA 92121, USA
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14
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Muacevic A, Adler JR, de Souza TF, Galvão Neto MDP, Grecco E, Waisberg J. Gastric Emptying and Its Correlation With Weight Loss and Body Mass Index in Patients With an Intragastric Balloon: A Prospective Study With Six Years of Follow-Up. Cureus 2022; 14:e32599. [PMID: 36654650 PMCID: PMC9840869 DOI: 10.7759/cureus.32599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Background Obesity is the most well-established and prolonged pandemic in modern society. Having a better understanding of the available tools is important to improve weight loss and make the strategies more productive. This study aims to evaluate the effect of intragastric balloon (IGB) on gastric emptying time, its relationship with weight loss after IGB removal, and weight maintenance after six years. Methodology This prospective study analyzed data from patients undergoing IGB placement. A six-years follow-up was performed and data about weight maintenance were collected. We analyzed the impact of the IGB on gastrointestinal motility and its correlation with weight loss. Results Of the 20 patients included in the study, 52.4% were diagnosed with class I obesity and 47.6% with class II obesity. The mean weight of the patients was 96.5 ± 11.9 kg at baseline, 79.6 ± 11.4 kg at the time of IGB removal, 81.8 ± 9.1 kg at six months, and 93.2 ± 14.3 kg six years after IGB removal. The mean difference between the initial weight and that measured immediately after IGB removal was 16.68 ± 5.71 kg. Regarding gastric emptying time, there was a difference in retention on comparing the measurement before balloon placement to that after the balloon was in place (72.9% vs. 86.8%) after one hour of food intake. Comparing two hours after food intake, patients before IGB placement had a 30.6% food retention, while patients with IGB in place had a 69.2% retention. Conclusions In patients with class I or II obesity, the use of an IGB delayed gastric emptying of foods but showed no direct correlation with weight loss. Weight loss achieved after IGB placement was maintained in half of the patients at a six-year follow-up.
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15
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Endobariatrics: well past infancy and maturing rapidly. Curr Opin Gastroenterol 2022; 38:592-599. [PMID: 36219127 DOI: 10.1097/mog.0000000000000884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the key developments with regard to FDA-approved endoscopic bariatric metabolic therapies (EBMTs) in the last 2 years. RECENT FINDINGS The prevalence of obesity has increased during the coronavirus disease 2019 (COVID-19) pandemic, and obesity worsens COVID-19 related outcomes. Several studies have confirmed the safety and short-term efficacy of intragastric balloons (IGBs). In the short-term IGBs may improve steatosis and fibrosis in nonalcoholic fatty liver disease and improve quality of life and mental health. Unfortunately weight loss from these temporarily placed devices is not sustained long-term. Endoscopic sleeve gastroplasty (ESG) may be more effective and durable than IGBs, and result in fewer adverse events compared to bariatric surgery. The recently completed MERIT trial may catapult ESG as a first-line EBMT. Aspiration therapy meets safety and effectiveness thresholds for incorporation into routine practice, but overall acceptance has been lower than other FDA-approved EBMTs. SUMMARY The field of endobariatrics is rapidly maturing. Significant knowledge gaps remain with regards to combining EBMTs with pharmacologic therapy to improve durability of weight loss. The rapid expansion in the literature supporting safety and long-term efficacy ESG may prompt revision of existing guidelines.
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Iacobellis F, Dell’Aversano Orabona G, Brillantino A, Di Serafino M, Rengo A, Crivelli P, Romano L, Scaglione M. Common, Less Common, and Unexpected Complications after Bariatric Surgery: A Pictorial Essay. Diagnostics (Basel) 2022; 12:2637. [PMID: 36359480 PMCID: PMC9689585 DOI: 10.3390/diagnostics12112637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 06/27/2024] Open
Abstract
Bariatric surgery has demonstrated a higher rate of success than other nonsurgical treatments in selected patients with obesity; however, like all medical procedures, postoperative complications may occur, ranging between 2 and 10% and, although rare, they can be life threatening. Complications may be unspecific (any surgery-related complications) or specific (linked to the specific surgical procedure) and can be distinguished as common, less common, and unexpected. According to the onset, they may be acute, when occurring in the first 30 days after surgery, or chronic, with a presentation after 30 days from the procedure. The aim of this pictorial essay is to review the radiological aspects of surgical techniques usually performed and the possible complications, in order to make radiologists more confident with the postsurgical anatomy and with the normal and abnormal imaging findings.
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Affiliation(s)
- Francesca Iacobellis
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy
| | | | - Antonio Brillantino
- Department of Emergency Surgery, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy
| | - Alessandro Rengo
- Department of Radiology, Pineta Grande Hospital, Via Domitiana KM 30, 81030 Castel Volturno, Italy
| | - Paola Crivelli
- Department of Surgery, Medicine and Pharmacy, University of Sassari, Via Roma 151, 07100 Sassari, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131 Naples, Italy
| | - Mariano Scaglione
- Department of Surgery, Medicine and Pharmacy, University of Sassari, Via Roma 151, 07100 Sassari, Italy
- Department of Radiology, The James Cook University Hospital, Middlesbrough TS4 3BW, UK
- School of Health and Life Sciences, Teesside University, Middlesbrough TS1 3BX, UK
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17
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Fadel MG, Fehervari M, Lairy A, Das B, Alyaqout K, Ashrafian H, Khwaja H, Efthimiou E. Clinical outcomes of single-stage versus two-stage laparoscopic Roux-en-y gastric bypass in the management of obesity (BMI ≥ 50 kg/m 2): a retrospective cohort study. Langenbecks Arch Surg 2022; 407:3349-3356. [PMID: 36050499 DOI: 10.1007/s00423-022-02664-9] [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: 05/09/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients with obesity, BMI ≥ 50 kg/m2, can be a challenging operation. Weight loss with intra-gastric balloon (IGB) insertion prior to LRYGB may improve operative outcomes. METHODS Between June 2000 and June 2020, patients with a BMI ≥ 50 kg/m2 underwent either IGB insertion followed by LRYGB (two-stage group), or LRYGB as the definitive bariatric procedure (single-stage group) in our institution. The two-stage procedure was adopted for high risk individuals. Primary outcome measures were percentage total weight loss (%TWL) at 24 months, length of stay and postoperative morbidity. Propensity score analysis was used to account for differences between groups. RESULTS A total of 155 (mean age 42.9 years ± 10.60; mean BMI 54.6 kg/m2 ± 4.53) underwent either the two-stage (n = 30) or single-stage procedure (n = 125) depending on preoperative fitness. At 6 months following LRYGB, there was a significant difference in %TWL between the groups in a matched analysis (11.9% vs 23.7%, p < 0.001). At 24 months, there was no difference in %TWL (32.0% vs 34.7%, p = 0.13). Median hospital stay following LRYGB was 2.0 (1-4) days with the two-stage vs 2.0 (0-14) days for the single-stage approach (p = 0.75). There was also no significant difference in complication rates (p = 0.058) between the two groups. CONCLUSIONS There was no difference in weight loss after one or two-stage procedures in the treatment of patients with a BMI ≥ 50 kg/m2 super obesity in a propensity score weighted analysis at 24 months. Length of stay and perioperative complications were similar for high risk patients; however, the two-stage approach was associated with delayed weight loss. Single-stage management is recommended for moderate risk patients, particularly with significant metabolic disorders, whilst two-stage approach is a safe and feasible pathway for high risk individuals.
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Affiliation(s)
- Michael G Fadel
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK.
- Imperial College London, London, UK.
| | - Matyas Fehervari
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
| | - Ali Lairy
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
- Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | | | - Khaled Alyaqout
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
- Jaber Al-Ahmad Al-Sabah Hospital, Kuwait City, Kuwait
| | - Hutan Ashrafian
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
| | - Haris Khwaja
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
| | - Evangelos Efthimiou
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
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Shetye B, Hamilton FR, Bays HE. Bariatric surgery, gastrointestinal hormones, and the microbiome: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. OBESITY PILLARS (ONLINE) 2022; 2:100015. [PMID: 37990718 PMCID: PMC10661999 DOI: 10.1016/j.obpill.2022.100015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 03/26/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians an overview of bariatric surgery (i.e., bariatric procedures that improve metabolic disease are often termed "metabolic and bariatric surgery"), gastrointestinal hormones, and the microbiome as they relate to patients with obesity. Methods The scientific information for this CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results This CPS includes the pros and cons of the most common types of bariatric procedures; the roles of gastrointestinal (GI) hormones in regulating hunger, digestion, and postabsorptive nutrient metabolism; and the microbiome's function and relationship with body weight. This CPS also describes patient screening for bariatric surgery, patient care after bariatric surgery, and treatment of potential nutrient deficiencies before and after bariatric surgery. Finally, this CPS explores the interactions between bariatric surgery, GI hormones, and the microbiome. Conclusions This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) regarding bariatric surgery, gastrointestinal hormones, and the microbiome is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity. Implementation of appropriate care before and after bariatric surgery, as well as an awareness of GI hormones and the microbiome, may improve the health of patients with obesity, especially patients with adverse fat mass and adiposopathic metabolic consequences.
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Affiliation(s)
- Bharti Shetye
- Diplomate American Board of Obesity Medicine, Medical Director, Dr. Abby's Weight Management Clinic, 6101 Webb Road, Suite 207, Tampa, FL, 33615, USA
| | - Franchell Richard Hamilton
- Diplomate American Board of Obesity Medicine, A Better Weigh Center, 8865 Davis Blvd Ste 100, Keller, TX, 76248, USA
| | - Harold Edward Bays
- Diplomate American Board of Obesity Medicine, Louisville Metabolic and Atherosclerosis Research Center, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville, KY, 40213, USA
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Al-Kadi A. Gastroscope-assisted laparoscopic sleeve gastrectomy: A case report with an unexpected old deflated intragastric balloon. Int J Surg Case Rep 2022; 95:107250. [PMID: 35636218 PMCID: PMC9149178 DOI: 10.1016/j.ijscr.2022.107250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/21/2022] [Accepted: 05/22/2022] [Indexed: 02/07/2023] Open
Abstract
Introduction and importance Obesity has become a global health crisis and is now considered a pandemic. Intragastric balloons (IGB) can aid obese patients achieve a better effect of weight loss than medications while being noninvasive compared to surgical therapy. Case presentation We report a case of a 42-yr-old female with difficulty in losing weight even after three attempts of IGB and several diet programs. At the time of presentation, the patients BMI was 46.2 kg/m2. The patient experienced no gastrointestinal symptoms or stomach complaints and was found to have morbid obesity with hypertension and glucose intolerance. Clinical discussion Laparoscopic sleeve gastrectomy (LSG) was suggested for the patient. While performing LSG in association with a gastroscope, an unexpected old and deflated gastric balloon was found residing inside the stomach cavity. The rest of the surgery had no difficulty after the old gastric balloon was removed. The patients BMI post-LSG after 18 months was noticed to be 26.6 kg/m2. Conclusion We recommend performing gastroscopy prior to LSG for every patient with a previous gastric balloon insertion, especially if they had it more than once, to avoid potential complications during surgery. Intragastric balloons (IGB) can aid obese patients achieve a better effect of weight loss than medications. A patient (Female, 42-yr-old) failed to reduce weight after three attempts of IGB. Hence, advised for laparoscopic sleeve gastrectomy. Gastroscopy was done to remove the old deflated IGB that was found inside the stomach cavity. We recommend gastroscopy prior to LSG for patients with a previous gastric balloon insertion to avoid potential complications during surgery
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20
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Berger ME, Løve US. Gastric perforation during second intragastric balloon treatment: a case report. AME Case Rep 2022; 6:15. [PMID: 35475007 PMCID: PMC9010319 DOI: 10.21037/acr-21-64] [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: 09/14/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2023]
Abstract
Intragastric balloon (IGB) is a widely used, minimal invasive treatment for obesity. The IGB reduce gastric capacity and enhance feeling of fullness, thereby inducing weight loss. A rare, but severe complication to IGB treatment is gastric perforation. We present a rare case of gastric perforation, occurring shortly after a second IGB treatment. The patient was first treated with an Orbera® IGB for 12 months, exceeding the recommended treatment period of 6 months. Upon removal, esophagitis and gastritis was found. Therefore, insertion of the second IGB was postponed. After only 9 treatment-free days, a new endoscopy revealed a macroscopical normal gastric mucosa, and the second Orbera® IGB was inserted. The day after the insertion the patient was admitted to the hospital, due to extensive vomiting and mild epigastric pain. Three days after the insertion a gastric perforation was found. The patient underwent endoscopic removal of the IGB and laparoscopic suture of the perforation. The postoperative course was complicated due to recurrent multiple intra abdominal abscesses, treated with antibiotics, drainage and abscess puncture on several occasions. We suggest that patients should be carefully evaluated before IGB treatments are repeated, especially when gastritis is present. If the gastric mucosa is affected, sufficient time to let it heal is needed. The recommended treatment period should not be exceeded, and perforation should always be suspected as a differential diagnosis when patients present with abdominal symptoms after IGB insertion.
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Affiliation(s)
| | - Uffe Schou Løve
- Part-time Lecturer, Department of Surgery, Viborg Regional Hospital, Viborg, Denmark
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21
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Al Harthy S, Al Lawati A, Al Lawati M. Severe Gastric Ulcerations With Impending Necrosis in a Patient Who Had Gastric Balloon Insertion Following Previous Sleeve Gastrectomy. Cureus 2022; 14:e22983. [PMID: 35415033 PMCID: PMC8994045 DOI: 10.7759/cureus.22983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/15/2022] Open
Abstract
In this report, we discuss the case of a 44-year-old obese female patient who had her recently installed intragastric balloon removed due to ulceration in the gastric mucosa, which would have led to necrosis as shown by oesophago-gastro-duodenoscopy (OGD). In addition, she had symptoms of nausea, vomiting, dysuria, fever, and experienced severe dehydration, which could have resulted in the formation of ureteric and renal stones. Thus, she was rehydrated and was started on antibiotics. She also underwent successful removal of the intragastric balloon aimed at preserving and healing of the remaining gastric mucosa. Post-op findings were unremarkable; however, a tight peptic stricture at the proximal stomach was formed four weeks after her balloon removal.
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22
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Hering I, Dörries L, Flemming S, Krietenstein L, Koschker AK, Fassnacht M, Germer CT, Hankir MK, Seyfried F. Impact of preoperative weight loss achieved by gastric balloon on peri- and postoperative outcomes of bariatric surgery in super-obese patients: a retrospective matched-pair analysis. Langenbecks Arch Surg 2022; 407:1873-1879. [PMID: 35257223 PMCID: PMC9399010 DOI: 10.1007/s00423-022-02472-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/14/2022] [Indexed: 02/07/2023]
Abstract
Background An intragastric balloon is used to cause weight loss in super-obese patients (BMI > 60 kg/m2) prior to bariatric surgery. Whether weight loss from intragastric balloon influences that from bariatric surgery is poorly studied. Methods In this retrospective, single-center study, the effects of intragastric balloon in 26 patients (BMI 69.26 ± 6.81) on weight loss after bariatric surgery (primary endpoint), postoperative complications within 30 days, hospital readmission, operation time, and MTL30 (secondary endpoints) were evaluated. Fifty-two matched-pair patients without intragastric balloon prior to bariatric surgery were used as controls. Results Intragastric balloon resulted in a weight loss of 17.3 ± 14.1 kg (BMI 5.75 ± 4.66 kg/m2) with a nadir after 5 months. Surgical and postoperative outcomes including complications were comparable between both groups. Total weight loss was similar in both groups (29.0% vs. 32.2%, p = 0.362). Direct postoperative weight loss was more pronounced in the control group compared to the gastric balloon group (29.16 ± 7.53% vs 23.78 ± 9.89% after 1 year, p < 0.05 and 32.13 ± 10.5% vs 22.21 ± 10.9% after 2 years, p < 0.05), who experienced an earlier nadir and started to regain weight during the follow-up. Conclusion A multi-stage therapeutic approach with gastric balloon prior to bariatric surgery in super-obese patients may be effective to facilitate safe surgery. However, with the gastric balloon, pre-treated patients experienced an attenuated postoperative weight loss with an earlier nadir and earlier body weight regain. This should be considered when choosing the appropriate therapeutic regime and managing patients’ expectations.
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Affiliation(s)
- Ilona Hering
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery; Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Luise Dörries
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery; Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Sven Flemming
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery; Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Wuerzburg, Germany.
| | - Laura Krietenstein
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery; Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Ann-Kathrin Koschker
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, Center of Internal Medicine (ZIM), University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, Center of Internal Medicine (ZIM), University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery; Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Mohammed K Hankir
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery; Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Florian Seyfried
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery; Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, Wuerzburg, Germany.
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Pontecorvi V, Bove V, Carlino G, Matteo MV, De Siena M, Papparella LG, Costamagna G, Boškoski I. Spontaneous Intragastric Balloon Hyperinflation Is Probably Due to Microbial Overgrowth of the Filling Liquid. Obes Surg 2022; 32:1783-1785. [PMID: 35246782 DOI: 10.1007/s11695-022-05984-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Valerio Pontecorvi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy. .,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
| | - Vincenzo Bove
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | | | - Maria Valeria Matteo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Martina De Siena
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Luigi Giovanni Papparella
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, 00168, Rome, Italy
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24
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Anderson J, Kushner R, Miller E, Nadglowski J, Still C. Overweight and Obesity Management for Primary Care Clinicians: Executive Summary. Clin Diabetes 2022; 41:85-89. [PMID: 36714253 PMCID: PMC9862448 DOI: 10.2337/cd22-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- John Anderson
- Frist Clinic, Nashville, TN
- Corresponding author: John Anderson,
| | - Robert Kushner
- Northwestern University Feinberg School of Medicine, Chicago, IL
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25
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Results of adjustable intragastric balloon use according to Body Mass Index values. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1058508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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26
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Anju T, Rai NKSR, Kumar A. Sauropus androgynus (L.) Merr.: a multipurpose plant with multiple uses in traditional ethnic culinary and ethnomedicinal preparations. JOURNAL OF ETHNIC FOODS 2022; 9:10. [PMCID: PMC8900104 DOI: 10.1186/s42779-022-00125-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Various plants form the basis of multiple traditional ethnic cuisines and ethnomedicinal practices across the globe. The ethnic cuisines cater to the nutritional, dietary and medicinal requirements of the tribal and rural communities even today. Using literature from various scholarly databases, this study was conducted to consolidate a comprehensive review on the use of Sauropus androgynus (L.) Merr. in various traditional ethnic cuisines and ethnomedicinal preparations across the globe. The survey shows that it is used in multiple ethnic cuisines and is variously known in different countries and among the communities. Further, it possesses multiple nutritional and ethnomedicinal properties. Considering its importance in ethnic foods and ethnomedicinal preparations, it is important to investigate the nutritional composition, phytochemical constitution and pharmacological basis of ethnomedicinal uses. Therefore, we further compiled this information and found that it is a rich source of both micro- and macronutrients and packed with several bioactive compounds. Survey of pharmacological studies on its traditional medicinal uses supports its ethnomedicinal properties. Despite its importance in traditional food and ethnomedicinal systems, it remains underexplored. Limited information on the toxicity of its various extracts shows that further studies should be conducted to understand its safety aspects. Further clinical studies to prospect possible drug candidates from it should be attempted.
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Affiliation(s)
- Thattantavide Anju
- Department of Plant Science, School of Biological Sciences, Central University of Kerala, Periye, Kasaragod, Kerala 671316 India
| | - Nishmitha Kumari S. R. Rai
- Department of Plant Science, School of Biological Sciences, Central University of Kerala, Periye, Kasaragod, Kerala 671316 India
| | - Ajay Kumar
- Department of Plant Science, School of Biological Sciences, Central University of Kerala, Periye, Kasaragod, Kerala 671316 India
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27
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Fluid-filled intragastric balloons are an effective and safe weight loss option across BMI and age ranges. Surg Endosc 2021; 36:5160-5166. [PMID: 34845556 DOI: 10.1007/s00464-021-08892-2] [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: 03/21/2021] [Accepted: 11/16/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Obesity is an expanding public health problem, resulting in more than half a billion adults worldwide. Intragastric balloon (IGB) placement is a weight loss alternative for obese patients with an inadequate weight loss response to diet and exercise. The aim of this study is to examine the efficacy and safety of the single-chamber fluid-filled IGB for weight loss and compare its results across different age groups. METHODS We performed a database review of 239 consecutive patients from two outpatient GI clinics who underwent placement of an IGB. Our final analysis composed of 239 IGB placements in 232 patients (mean age, 44.5 ± 10.3 years; 67% female; baseline BMI 42.0 ± 9.0). Efficacy outcomes included the percentage of the total (%TWL) and excess weight loss (%EWL). Safety outcomes were measured as the number of patients who required early IGB removal (before 6 months). RESULTS %TWL at 3 months was 10.1% and 14.4% at 6 months. Overall, 92%, 74%, and 47% of patients lost 5%, 10%, and 15% of total weight at 6 months, respectively. %EWL was 22.1% and 30.7% at 3 and 6 months post-IGB placement, respectively. The balloon was safely removed at six months after placement in most patients, whereas in 13.0% of cases early removal was performed at an average of 12.0 weeks after placement (range, 2 days-23 weeks). CONCLUSION The use of a single-chamber fluid-filled IGB is successful in inducing a significant amount of weight loss in almost three-fourths of patients six months after its placement. This beneficial effect is seen across different BMI ranges and age groups at a similar level. IGBs should be considered an effective and safe alternative for obese patients who fail lifestyle interventions and conservative measures, fulfilling the unmet needs of many who are unwilling or unable to undergo bariatric surgery.
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28
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Loo JH, Lim YH, Seah HL, Chong AZQ, Tay KV. Intragastric Balloon as Bridging Therapy Prior to Bariatric Surgery for Patients with Severe Obesity (BMI ≥ 50 kg/m 2): a Systematic Review and Meta-analysis. Obes Surg 2021; 32:489-502. [PMID: 34787766 DOI: 10.1007/s11695-021-05772-5] [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: 07/17/2021] [Revised: 10/15/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
Bariatric surgery for patients with severe obesity (body mass index (BMI) ≥ 50kg/m2) is technically challenging. Intragastric balloon (IGB) has been proposed for weight loss before bariatric surgery to reduce surgical risks but its efficacy remains unclear. We conducted a systematic review and meta-analysis of the effectiveness of IGB as bridging therapy and assess potential complications. Amongst 2419 citations, 13 studies were included. IGB resulted in a BMI reduction of 6.60 kg/m2 (MD=6.60, 95% CI: 5.06-8.15; I2=72%). The total post-procedural complication rate was 8.13% (95% CI: 4.04-13.17%), with majority being balloon intolerance. Overall, IGB is effective as a bridging therapy with adequate procedural safety profile, but further study is needed to evaluate the risk reduction for bariatric surgery and long-term weight-loss outcomes.
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Affiliation(s)
- Jing Hong Loo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Yao Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hwee Ling Seah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Kon Voi Tay
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.,Department of General Surgery, Woodlands Health Campus, Singapore, Singapore
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29
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Abstract
With the recent urbanization and globalization, the adult obesity rate has been increasing, which was paralleled with a dramatic surge in the incidence and prevalence of nonalcoholic fatty liver disease (NAFLD). NAFLD poses a growing threat to human health as it represents the most common cause of chronic liver disease in developed countries. It encompasses a wide spectrum of conditions starting from a build-up of fat in hepatocytes (steatosis), to developing inflammation (steatohepatitis), and reaching up to cirrhosis. It is also associated with higher rates of cardiovascular mortalities. Therefore, proper timely treatment is essential and weight loss remains the cornerstone in the treatment of obesity-related liver diseases. When diet, exercise, and lifestyle changes are not successful, the current recommendation for weight loss includes antiobesity medications and bariatric endoscopic and surgical interventions. These interventions have shown to result in significant weight loss and improve liver steatosis and fibrosis. In the current literature review, we highlight the expected outcomes and side effects of the currently existing options to have a weight-centric NAFLD approach.
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Affiliation(s)
- Anas Hashem
- Division of Gastroenterology and Hepatology, Department of Medicine, Precision Medicine for Obesity Program, Mayo Clinic, Rochester, Minnesota
| | - Amani Khalouf
- Division of Gastroenterology and Hepatology, Department of Medicine, Precision Medicine for Obesity Program, Mayo Clinic, Rochester, Minnesota
| | - Andres Acosta
- Division of Gastroenterology and Hepatology, Department of Medicine, Precision Medicine for Obesity Program, Mayo Clinic, Rochester, Minnesota
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30
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Ramai D, Singh J, Mohan BP, Madedor O, Brooks OW, Barakat M, Ofosu A, Khan SR, Chandan S, Dhindsa B, Dhaliwal A, Facciorusso A, McDonough S, Adler DG. Influence of the Elipse Intragastric Balloon on Obesity and Metabolic Profile: A Systematic Review and Meta-Analysis. J Clin Gastroenterol 2021; 55:836-841. [PMID: 33394629 DOI: 10.1097/mcg.0000000000001484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Intragastric balloons (IGBs) have been used to bridge the obesity treatment gap with the benefits of being minimally invasive but still required endoscopy. The Elipse IGB is a swallowable balloon that is spontaneously excreted at ∼16 weeks. However, studies are limited by small sample sizes. The authors aim to assess clinically relevant endpoints, namely weight loss outcomes, metabolic profile, balloon tolerability, and adverse events. METHODS A literature search was performed from several databases from inception to July 2020. The pooled means and proportions of our data were analyzed using a random effects model. RESULTS Seven studies involving 2152 patients met our eligibility criteria and were included. The mean baseline body mass index ranged from 32.1 to 38.6. The pooled mean difference (MD) in body mass index was 0.88 [confidence interval (CI): 0.58-1.18, I2=98%]. Total body weight loss was 12% (CI: 10.1-14.3, I2=94%) and excess body weight loss was 49.1% (CI: 30.6-67.5, I2=97%). The MD in waist circumference was 0.89 (CI: 0.72-1.05, I2=53%). MD in triglyceride level was 0.66 (CI: 0.21-1.1, I2=96%). Pooled early deflation rate was 1.8% (CI: 0.6-5.1, I2=74%). Our study also showed that the Elipse balloon was associated with less adverse events when compared with other IGBs. CONCLUSIONS This meta-analysis demonstrates that the Elipse intragastric balloon is a safe, effective, and tolerable device for weight loss and obesity with a minimal side effect profile.
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Affiliation(s)
| | - Jameel Singh
- Department of Internal Medicine, Mathers Hospital, Port Jefferson, NY
| | - Babu P Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Ogenetega Madedor
- Department of Medicine, Spectrum Health Hospital/Michigan State University, Grand Rapids, MI
| | - Olivia W Brooks
- Department of Internal Medicine
- St. George's University School of Medicine, Grenada, WI
| | - Mohamed Barakat
- Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn
| | - Andrew Ofosu
- Division of Gastroenterology, Stanford University, Stanford, CA
| | - Shahab R Khan
- Division of Gastroenterology, Rush University Medical Center, Chicago, II
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Health Creighton University Medical Center
| | - Banreet Dhindsa
- Department of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE
| | - Amaninder Dhaliwal
- Division of Gastroenterology, Moffitt Cancer Center, University of South Florida, Tampa, FL
| | - Antonio Facciorusso
- Section of Gastroenterology, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Stephanie McDonough
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT
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31
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Smart pills for gastrointestinal diagnostics and therapy. Adv Drug Deliv Rev 2021; 177:113931. [PMID: 34416311 DOI: 10.1016/j.addr.2021.113931] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/03/2021] [Accepted: 08/13/2021] [Indexed: 12/13/2022]
Abstract
Ingestible smart pills have the potential to be a powerful clinical tool in the diagnosis and treatment of gastrointestinal disease. Though examples of this technology, such as capsule endoscopy, have been successfully translated from the lab into clinically used products, there are still numerous challenges that need to be overcome. This review gives an overview of the research being done in the area of ingestible smart pills and reports on the technical challenges in this field.
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32
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Al Ghadeer HA, AlFuraikh BF, AlMusalmi AM, AlJamaan LF, Kurdi E. Acute Pancreatitis as a Complication of Intragastric Balloon. Cureus 2021; 13:e16710. [PMID: 34466335 PMCID: PMC8399293 DOI: 10.7759/cureus.16710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 11/05/2022] Open
Abstract
The intragastric balloon is a common minimally invasive procedure used prior to bariatric surgery for weight reduction. There are complications of this balloon with varying degrees of severity ranging from mild to severe life-threatening complications. Acute pancreatitis due to direct compression or catheter migration of the balloon should be considered in these patients. In the literature, there is little evidence that intragastric balloons could cause acute pancreatitis. We present two cases in which they had a history of IGB insertion complicated by acute pancreatitis. The diagnosis of acute pancreatitis due to the intragastric balloon was made after excluding other possible causes of acute pancreatitis. Both patients were hospitalized and managed conservatively.
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Affiliation(s)
| | | | | | | | - Ezzeddin Kurdi
- Gastroenterology, King Fahad Hospital Hofuf, AlAhsa, SAU
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33
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Freitas RB, Rodrigues JA, Puga H, Correia JH. Design, simulation, and fabrication of an ingestible capsule with gastric balloon for obesity treatment. Biomed Phys Eng Express 2021; 7. [PMID: 34388748 DOI: 10.1088/2057-1976/ac1d88] [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: 05/12/2021] [Accepted: 08/13/2021] [Indexed: 11/11/2022]
Abstract
The treatment of obesity based only on lifestyle changes has been shown ineffectiveness in a long-term period. The development of more definitive and non-invasive therapies has been the subject of study. In this paper, a magnetically driven ingestible capsule with the capacity to inflate a gastric balloon is devised, simulated, and fabricated. The balloon is inflated to a volume of 150 ml using an acid-base reaction between citric acid and potassium bicarbonate. Finite element method simulations were performed to study the interaction between the permanent external magnet and the ingestible capsule and confirm the magnetic activation mechanism. A fabrication process was proposed to manufacture a polydimethylsiloxane (PDMS) balloon in a simple, functional, and reproducible way. The two layers and 1:8 ratio balloons are the most cost-effective without compromising their mechanical properties. The capsule body parts manufactured by a three-dimensional (3D) printing process - Digital Light Processing (DLP) showed high accuracy and excellent resolution. This study demonstrated that the proposed ingestible capsule would successfully inflate the gastric balloon to treat obesity.
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Affiliation(s)
- R B Freitas
- CMEMS-UMinho, University of Minho, Campus Azurém, 4800-058, Guimarães, Portugal
| | - J A Rodrigues
- CMEMS-UMinho, University of Minho, Campus Azurém, 4800-058, Guimarães, Portugal
| | - H Puga
- CMEMS-UMinho, University of Minho, Campus Azurém, 4800-058, Guimarães, Portugal
| | - J H Correia
- CMEMS-UMinho, University of Minho, Campus Azurém, 4800-058, Guimarães, Portugal
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34
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Staudenmann DA, Sui Z, Saxena P, Kaffes AJ, Marinos G, Kumbhari V, Aepli P, Sartoretto A. Endoscopic bariatric therapies for obesity: a review. Med J Aust 2021; 215:183-188. [PMID: 34333788 DOI: 10.5694/mja2.51179] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
▪ Obesity is reaching pandemic proportions globally, with overweight or obesity affecting at least two-thirds of Australian adults. ▪ Bariatric surgery is an effective weight loss strategy but is constrained by high resource requirements and low patient acceptance. ▪ Multiple endoscopic bariatric therapies have matured, with well established and favourable safety and efficacy profiles in multiple randomised controlled trials (RCTs), and are best used within a multidisciplinary setting as an adjuvant to lifestyle intervention. ▪ Three types of intragastric balloon are currently in use in Australia offering average total weight loss ranging from 10% to 18%, with others available internationally. ▪ Endoscopic sleeve gastroplasty produces average total weight loss of 15-20% with low rates of severe complications, with RCT data anticipated in December 2021. ▪Bariatric and metabolic endoscopy is rapidly evolving, with many novel, promising therapies currently under investigation.
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Affiliation(s)
- Dominic A Staudenmann
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW.,Praxis Balsiger Seibold und Partner, Bern, Switzerland.,Université de Fribourg, Fribourg, Switzerland
| | | | | | - Arthur J Kaffes
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW
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35
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Kim SY. The Effect of Endoscopic Bariatric and Metabolic Therapies on Gastroesophageal Reflux Disease. ACTA ACUST UNITED AC 2021; 57:medicina57080737. [PMID: 34440943 PMCID: PMC8401395 DOI: 10.3390/medicina57080737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/07/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
Obesity is a chronic disease that is becoming increasingly more prevalent and is associated with many health problems, such as metabolic syndrome. The treatment options for obese patients include lifestyle modification, medications, endoscopic bariatric and metabolic therapies (EBMTs), and surgery. In particular, EBMTs have an excellent therapeutic effect and are less invasive than bariatric surgery. Although it is clear that EBMTs are relatively safe procedures, they can result in several adverse events. Among them, the relationship between EBMTs and gastroesophageal reflux disease (GERD) is unclear. Several studies have demonstrated that an intragastric balloon (IGB) may worsen GERD. There are a few studies on the effects of endoscopic sleeve gastroplasty (ESG) on GERD, but the linking evidence is insufficient. However, the conclusion is not simple. Because obesity is an important cause of GERD, and GERD naturally improves with weight loss after EBMTs, it is not easy to evaluate accurately the effect of EBMTs on GERD. This review aimed to discuss the effect of EBMTs on GERD and suggest future research directions.
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Affiliation(s)
- Su-Young Kim
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 26426, Korea
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36
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Bomman S, Sanders D, Larsen M. Spontaneous Hyperinflation of an Intragastric Balloon Causing Gastric Outlet Obstruction. Cureus 2021; 13:e15962. [PMID: 34211818 PMCID: PMC8236270 DOI: 10.7759/cureus.15962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 11/23/2022] Open
Abstract
A 39-year-old female with a history of obesity (body mass index, BMI = 33.6) had an intragastric balloon (IGB) placed in February 2020 for weight loss. She presented with gastric outlet obstruction after a delay in the removal of her IGB because of the coronavirus disease (COVID) pandemic. Although uncommon, spontaneous hyperinflation of IGBs has been reported and the US FDA also has issued a warning regarding the risk of spontaneous hyperinflation. The etiology of the hyperinflation is unclear, however, gas-forming micro-organism contamination of the IGB fluid has been reported.
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Affiliation(s)
| | - David Sanders
- Gastroenterology, Virginia Mason Medical Center, Seattle, USA
| | - Michael Larsen
- Gastroenterology, Virginia Mason Medical Center, Seattle, USA
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37
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The Efficacy and Safety of a Procedureless Gastric Balloon for Weight Loss: a Systematic Review and Meta-Analysis. Obes Surg 2021; 30:3341-3346. [PMID: 32266698 DOI: 10.1007/s11695-020-04522-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intragastric balloons have been used to bridge the obesity treatment gap with the benefits of being minimally invasive but still required endoscopy. The Elipse intragastric balloon (EIGB) is a swallowable balloon that is spontaneously excreted through a natural orifice at approximately 16 weeks. Several concerns exist, including the treatment efficacy and risk of bowel obstruction. Our meta-analysis aimed to evaluate the efficacy and safety of EIGB. METHODS A literature search was performed from several databases from database inception to November 2019. Eligible studies must report percent total weight loss (%TWL) after completion of treatment and adverse events. The pooled means and proportions of our data were analyzed using random effects model, generic inverse variance method. RESULTS Six studies involving 2013 unique patients met our eligibility criteria and were included. The mean baseline BMI ranged from 30.6 to 36.2. The pooled early removal rate was 2.3% (95% CI, 1.1-3.5%; I2 31%). The pooled %TWL after completion of treatment (4-6 months) was 12.8% (95% CI, 11.6-13.9%; I2 83%) and at 12 months was 10.9% (95% CI, 5.0-16.9%, I2 98%). For serious adverse events, three patients had small bowel obstruction, and one patient had gastric perforation requiring surgery. Early expulsion by emesis and early deflation were seen in 3 and 9 patients, respectively. CONCLUSIONS This meta-analysis demonstrates that EIGB is a safe device offering an effective weight loss that warrants further studies for its long-term weight loss outcomes. Severe adverse events are rare, and the rate of early removal is low.
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38
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Pak HJ, Choi HN, Lee HC, Yim JE. Effects of intragastric balloon on obesity in obese Korean women for 6 months post removal. Nutr Res Pract 2021; 15:456-467. [PMID: 34349879 PMCID: PMC8313389 DOI: 10.4162/nrp.2021.15.4.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/15/2020] [Accepted: 01/07/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/OBJECTIVES The prevalence of morbid obesity in Korean women has consistently been increasing, while the overall prevalence rate of obesity in Korean women seems to be stable. In addition to bariatric surgery, intragastric balloons (IGBs), as a nonsurgical therapy, have been reported to be effective in weight loss. However, the beneficial effects of IGB in Korean women with obesity have not been fully investigated. The aim of this study was to evaluate the changes in fat mass in Korean women with obesity who had undergone IGB treatment for 6 mon. SUBJECTS/METHODS Seventy-four women with obesity (body mass index [BMI] ≥ 25.0 kg/m2) were recruited. Clinical data, including general information, comorbidities with obesity, anthropometric data, and changes in the body fat composition before and after IGB treatment, were obtained from the subjects. RESULTS Most subjects had one or more comorbidities, such as osteoarthropathy and woman's disease, and had poor eating behaviors, including irregular mealtimes, eating quickly, and frequent overeating. Body composition measurements showed that weight, fat mass, and waist-hip circumference ratio decreased significantly at 6 mon after IGB treatment. In particular, women with morbid obesity (BMI ≥ 30 kg/m2) showed 33% excess weight loss. There was no significant difference in skeletal muscle mass and mineral contents after IGB treatment. CONCLUSIONS This study suggested that 6 mon of IGB treatment can be a beneficial treatment for obesity without muscle mass and bone mineral loss.
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Affiliation(s)
- Hyeon-Ju Pak
- Department of Food and Nutrition, Changwon National University, Changwon 51140, Korea
| | - Ha-Neul Choi
- Department of Food and Nutrition, Changwon National University, Changwon 51140, Korea
| | | | - Jung-Eun Yim
- Department of Food and Nutrition, Changwon National University, Changwon 51140, Korea.,Interdisciplinary Program in Senior Human Ecology (BK21 Four Program), Changwon National University, Changwon 51140, Korea
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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.
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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
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Choe Y, Kim JS, Kim BW. Short-term Outcomes of Intragastric Balloon Placement for Obesity Treatment. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2020. [DOI: 10.7704/kjhugr.2020.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Endoscopic treatment for obesity, especially intragastric balloon insertion, is on the rise in Korea. From 2016 to 2019, we performed intragastric balloon placement for the treatment of obesity in 12 patients at a single tertiary center. One balloon was removed on the next day due to nausea and severe abdominal pain, and the remaining 11 patients were followed up for 6 months. Body weight reduction of 8.9±5.4 kg was achieved, and the body mass index was reduced by 3.3±2.0 kg/m<sup>2</sup>. Significant effects regarding total body weight loss and excess weight loss were noted. The effect of weight reduction was greatest within 1 month after the procedure. Low density lipoprotein cholesterol significantly decreased by 18.0±18.2 mg/dL, but there were no significant changes in blood pressure, fasting blood glucose, total cholesterol, triglyceride, and high density lipoprotein cholesterol. Common adverse events were nausea and epigastric pain, but no serious adverse events occurred. Further studies regarding the long-term effects of endoscopic treatment for obesity and the improvement of metabolic syndrome are needed.
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Vinod VC, Younis MU, Mubarik H, Rivas H. A rare case of gastric perforation by a 5-year-old Intra-gastric Balloon in situ: Case report and review of literature. Int J Surg Case Rep 2020; 76:480-483. [PMID: 33207414 PMCID: PMC7586043 DOI: 10.1016/j.ijscr.2020.10.028] [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] [Received: 09/11/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 12/27/2022] Open
Abstract
5-Year-old Intra-gastric Balloon. Gastric perforation. Acute abdomen. Bariatric surgery.
Introduction Insertion of an Intra gastric Balloon (IGB) has widely been used as a minimally invasive procedure for the treatment of obesity. Gastric balloons are usually inserted for a period of six months only. They have a high safety profile and one of their rare, reported, serious complications include gastric or esophageal perforation, which are usually early and require immediate operative management. Presentation of case We report a 26-year-old lady who presented to the ED with signs and symptoms of acute abdomen and five-year history of endoscopic placement of Intra-gastric Balloon. Emergent endoscopic removal of the balloon revealed a large pressure ulcer at gastric incisura with central necrosis. Laparoscopy confirmed gastric perforation along lesser curvature with extensive soilage of peritoneal cavity. Extensive irrigation and drainage and Graham omental patch repair were carried out laparoscopically, and the perforation sealed satisfactorily. She recovered well from surgery and within days she was tolerating a diet. Broad spectrum IV antibiotics were given for 10 days. Discussion Gastric perforation is a rare complication reported in 0.1% of patients undergoing IGB insertion. It can ensue as early as days after placement or late at weeks to months. In our review of literature, we found the maximum time frame in which a patient presented with an IGB induced gastric perforation was at 22 months. This makes our case unique as the patient was able to tolerate it for 5 years (60 months) before presenting to the emergency with this sinister complication. Conclusion Very late Gastric perforations in patients with IGB placement are rare. An upper gastrointestinal endoscopy should be arranged as soon as possible to remove the balloon and assess the stomach visualize the perforation followed by a laparoscopic approach to repair the defect if expertise is available.
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Affiliation(s)
- Vijay Chander Vinod
- Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates.
| | | | - Humera Mubarik
- Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates.
| | - Homero Rivas
- Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates.
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Lew D, Thampy C, Hawasli A. Lack of efficacy of dual intragastric balloon therapy on weight loss and patient dissatisfaction. Am J Surg 2020; 221:581-584. [PMID: 33190789 DOI: 10.1016/j.amjsurg.2020.11.010] [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: 08/01/2020] [Revised: 10/28/2020] [Accepted: 11/06/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dual intragastric balloon (DIGB) therapy is a non-surgical, restrictive method of weight loss. We evaluated weight loss and patient satisfaction after DIGB removal. METHODS Between 2016 and 2019, 35 patients had DIGB therapy. A retrospective review of weight loss at balloon removal and follow-up, adverse events during DIGB therapy, and patient satisfaction was performed. RESULTS At follow-up after balloon removal (22.3 ± 10.5 months), mean percent excess weight loss (%EWL) was significantly decreased compared to %EWL at removal (4.7 ± 42.7% vs 32.4 ± 38.8%, p = .001). Weight regain occurred in 22/31 (71%) patients. Adverse events during DIGB therapy included: nausea, abdominal pain, reflux, pancreatitis, and gastric outlet obstruction. Twenty-five (71.4%) patients completed a satisfaction questionnaire. Only 3/25 (12%) patients were satisfied, and 92% would not choose DIGB for weight loss. CONCLUSION Weight loss achieved from DIGB on average was not maintained after balloon removal. Most patients were not satisfied and would not choose DIGB again.
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Affiliation(s)
- David Lew
- Department of Surgery, Ascension St. John Hospital, 22101 Moross Rd, Detroit, MI, 48236, USA; Beaumont Hospital Grosse Pointe, 468 Cadieux Rd, Grosse Pointe, MI, 48230, USA
| | - Chelsea Thampy
- Department of Surgery, Ascension St. John Hospital, 22101 Moross Rd, Detroit, MI, 48236, USA
| | - Abdelkader Hawasli
- Department of Surgery, Ascension St. John Hospital, 22101 Moross Rd, Detroit, MI, 48236, USA; Beaumont Hospital Grosse Pointe, 468 Cadieux Rd, Grosse Pointe, MI, 48230, USA.
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Reddy VY, Neužil P, Musikantow D, Sramkova P, Rosen R, Kipshidze N, Kipshidze N, Fried M. Transcatheter Bariatric Embolotherapy for Weight Reduction in Obesity. J Am Coll Cardiol 2020; 76:2305-2317. [DOI: 10.1016/j.jacc.2020.09.550] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/28/2020] [Accepted: 09/12/2020] [Indexed: 02/07/2023]
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Kolli S, Ofosu A, Gurram H, Weissman S, Dang‐Ho PK, Mehta TI, Gill H, Gurram KC. Hidden dangers and updated labels on gastric balloons. Clin Case Rep 2020; 8:2116-2120. [PMID: 33235739 PMCID: PMC7669380 DOI: 10.1002/ccr3.2730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/16/2020] [Accepted: 01/27/2020] [Indexed: 11/10/2022] Open
Abstract
In recent years, intragastric balloons (IGBs) have emerged as an efficacious, nonsurgical modality to treat obesity. We present a case in which an IGB caused a gastric ulcer, only unearthed after the novel technique of deflation and early retrieval.
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Affiliation(s)
- Sindhura Kolli
- Department of Medicine, NYU Langone Comprehensive Program on ObesityNYU Grossman School of MedicineNew YorkNYUSA
| | - Andrew Ofosu
- Department of Gastroenterology and HepatologyThe Brooklyn Hospital CenterBrooklynNYUSA
| | - Harini Gurram
- Department of Internal MedicineNorthwestern UniversityChicagoILUSA
| | - Simcha Weissman
- Department of Internal MedicineHackensack University‐Palisades Medical CenterNorth BergenNJUSA
| | - Paul Khoi Dang‐Ho
- Department of Medicine, NYU Langone Comprehensive Program on ObesityNYU Grossman School of MedicineNew YorkNYUSA
| | - Tej I. Mehta
- Department of MedicineSouth Dakota Sanford School of MedicineSioux FallsSDUSA
| | - Hailie Gill
- Department of Gastroenterology and HepatologyThe Brooklyn Hospital CenterBrooklynNYUSA
| | - Krishna C. Gurram
- Department of Gastroenterology and HepatologyThe Brooklyn Hospital CenterBrooklynNYUSA
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Wu L, Dai X, Zhao W, Huang H, Mo L, Wu X. [Intragastric balloon for weight reduction: rationale, benefits, risks and indications]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:1525-1529. [PMID: 33118505 DOI: 10.12122/j.issn.1673-4254.2020.10.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Intragastric balloon (IGB) placement under endoscopy is a non-invasive method for weight loss.By placing a space-occupying balloon in the stomach, IGB treatment can achieve better effect of weight loss than medications.Herein we review the development of IGB, its effect on weight loss and the mechanism, and the eligible individuals for IGB treatment.We also examine the high-intensity postoperative management following IGB placement, which is important for maintaining long-term weight loss, and discuss the future development of IGB.The patients should understand that on the basis of ensuring a high safety, the weight-losing effect of IGB can be limited and relies heavily on postoperative management.Patients should make a decision on IGB placement after careful consideration of their own physical, economic, and psychological conditions, lifestyle and the line of work in addition to the indications of IGB.IGB placement combined with high-intensity postoperative management and active interventions of lifestyle and dietary habits help to achieve long-term effect of weight loss and improve obesity-related complications.
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Affiliation(s)
- Liangping Wu
- Surgical Center for Obesity and Diabetes, Jinshazhou Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510168, China.,UDM Medical Group, Guangzhou 510168, China
| | - Xiaojiang Dai
- Surgical Center for Obesity and Diabetes, Jinshazhou Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510168, China.,UDM Medical Group, Guangzhou 510168, China
| | - Weiguo Zhao
- Surgical Center for Obesity and Diabetes, Jinshazhou Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510168, China.,UDM Medical Group, Guangzhou 510168, China
| | - Hongyan Huang
- Surgical Center for Obesity and Diabetes, Jinshazhou Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510168, China.,UDM Medical Group, Guangzhou 510168, China
| | - Li Mo
- Surgical Center for Obesity and Diabetes, Jinshazhou Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510168, China.,UDM Medical Group, Guangzhou 510168, China
| | - Xiaofeng Wu
- Surgical Center for Obesity and Diabetes, Jinshazhou Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510168, China.,UDM Medical Group, Guangzhou 510168, China
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Randomized Prospective Clinical Study of Spatz3® Adjustable Intragastric Balloon Treatment with a Control Group: a Large-Scale Brazilian Experiment. Obes Surg 2020; 31:787-796. [PMID: 33001381 DOI: 10.1007/s11695-020-05014-0] [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] [Received: 06/09/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND To analyze the results regarding weight loss and complications related to the Spatz3® adjustable intragastric balloon (IGB) in Brazil. METHODS This randomized prospective study covered patients who had undergone treatment using a Spatz3® adjustable IGB between October 2016 and June 2018 at a private clinic in Rio de Janeiro, Brazil. The patients had a minimum body mass index (BMI) of 27 kg/m2. The study examined complications of Spatz3® treatment and BMI reduction, percentage of total weight loss (%TWL), and % of excess weight loss (%EWL). RESULTS One hundred eighty patients underwent a Spatz3® balloon implant in the period. The patients were randomly divided into one group in which the Spatz balloon was kept at the same volume (600 mL) throughout treatment (Control Group), and another adjustment group with 250 mL greater volume. The complication rate was 16.14%. No death or major complication occurred during the study. Mean BMI decreased from 39.51 to 32.84 kg/m2 (p < 0.0001), bodyweight from 111.87 to 90.28 kg (p < 0.0001), and excess weight from 41.55 to 22.99 kg (p < 0.0001). The adjustment resulted in greater mean weight loss of 4.35 kg (- 8 to 17.6 kg), and the average time of the procedure was 7.12 ± 1.63 months. The upward adjustment group did not present greater %TWL, %EWL, or BMI reduction when compared with the control group (p = 0.4413, p = 0,9245, p = 0.2729, respectively). CONCLUSION This study shows that Spatz3® IGB treatment is an effective procedure for weight reduction, with no mortality but higher morbidity compared with traditional IGBs. This procedure also enabled the balloon to stay in place for longer. The efficacy of upward adjustment still requires further confirmation.
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Intragastric Balloon: a Retrospective Evaluation of 5874 Patients on Tolerance, Complications, and Efficacy in Different Degrees of Overweight. Obes Surg 2020; 30:4892-4898. [PMID: 32959329 DOI: 10.1007/s11695-020-04985-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic methods, especially the intragastric balloon (IGB), have been shown to be effective for the treatment of excess weight. This study aimed to assess the tolerance, complications, and efficacy of excess weight treatment with a non-adjustable IGB during 6 months. METHODS A total of 5874 patients treated with a liquid-filled IGB (600-700 mL) and followed up by a multidisciplinary team were evaluated. Participants presented an initial body mass index (BMI) ≥ 25 kg/m2 and were stratified according to sex and degree of overweight (overweight and obesity grades I, II, and III). RESULTS The incidence of complications was 7.32% (n = 430): 6.10% (n = 357) early IGB removal, 0.20% (n = 12) gas production inside the balloon, 0.54% (n = 32) leakage, 0.32% (n = 19) pregnancy, 0.07% (n = 4) gastric perforation, 0.05% (n = 3) upper digestive bleeding, 0.01% (n = 1) Wernicke-Korsakoff syndrome due to excessive vomiting, and 0.02% each (n = 1) pancreatitis and esophagus perforation. The 5444 remaining patients (4081 women, 38 ± 38 years) presented a weight loss of 19.13 ± 8.86 kg and a BMI decreased significantly (p < 0.0001) (36.94 ± 5.67 vs. 30.08 ± 5.06 kg/m2). The % total weight loss (%TWL) was 18.42 ± 7.25%, and the % excess weight loss (%EWL) was 65.66 ± 36.24%. The treatment success rate (%TWL ≥ 10%) was 85%. The %EWL was higher in the pre-obese group (122.19%), followed by obesity grades I (76.67%), II (56.01%), and III (45.45%), with p < 0.0001 for each group. %EWL was higher in women (69.71%) than in men (53.39), with p < 0.0001 for each group. There was also a statistical difference between the TWL and EWL groups, with p < 0.001 for all analyses. CONCLUSION Endoscopic IGB treatment for excess weight is an excellent therapeutic option for patients with different degrees of overweight.
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Changes in Body Adiposity, Dietary Intake, Physical Activity and Quality of Life of Obese Individuals Submitted to Intragastric Balloon Therapy for 6 Months. Obes Surg 2020; 29:843-850. [PMID: 30536199 DOI: 10.1007/s11695-018-3609-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Obesity is an important risk factor for several chronic diseases and also is associated with worse quality of life. Intragastric balloon (IGB) is an effective method for weight loss. Although changes in lifestyle are critical to weight loss during and after IGB therapy, only a few studies evaluated dietary intake and none evaluated changes in physical activity with a validated questionnaire during the treatment. The aim of this study was to evaluate changes in total and central body adiposity, dietary intake, physical activity, and quality of life of patients with obesity submitted to IGB treatment for 6 months. METHODS 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 total and central body adiposity (anthropometry and bioelectrical impedance), dietary intake, physical activity (Baecke questionnaire), and quality of life (SF-36 questionnaire). RESULTS There was a significant decrease in total and central body adiposity. The mean % total weight loss and % excess weight loss were 15.88 ± 1.42 and 56.04 ± 4.90, respectively and waist circumference decreased 13.33 ± 1.39 cm. There was a reduction in energy intake, an increase in physical activity, and an improvement of quality of life during IGB treatment. CONCLUSION The present study suggests that IGB treatment during 6 months in individuals with obesity is effective for decreasing total and central body adiposity being associated with reduction in energy intake, increase in physical activity, and improvement in quality of life.
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In vivo degradation study of polyvinylidene fluoride/polybutylene succinate/modified organic montmorillonite nanocomposite films implanted in the gastrointestinal tract. Polym Degrad Stab 2020. [DOI: 10.1016/j.polymdegradstab.2019.109058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Haddad AE, Rammal MO, Soweid A, Shararra AI, Daniel F, Rahal MA, Shaib Y. Intragastric balloon treatment of obesity: Long-term results and patient satisfaction. TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 30:461-466. [PMID: 31061001 DOI: 10.5152/tjg.2019.17877] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND/AIMS Intragastric balloon (IGB) treatment of obesity is a minimally invasive outpatient procedure that has been shown to help weight loss in some patients. The aim of this study is to analyze the long-term results regarding the effectiveness, tolerability, and patient satisfaction in a cohort of patients undergoing the IGB insertion. MATERIALS AND METHODS Using a retrospective cohort study design, patients who had their IGB inserted/removed between the years 2009 and 2016 were contacted by phone and asked to answer a short questionnaire. The baseline characteristics, pre- and post- IGB weight, as well as their current weight were recorded. Different parameters of satisfaction were noted in addition to whether patients resorted to alternative weight-reduction measures. RESULTS Ninety-nine eligible patients were contacted, and 65 consented to the study. The average weight loss achieved at the end of the treatment period (3 to 10 months) was approximately a 12% decrease from the baseline. Only 39% of patients were satisfied with the procedure, and less than 50% were satisfied with the weight loss achieved. When assessing the long-term follow-up, years after the IGB removal (3.3±1.76 years), the vast majority of patients (78.7%) regained weight or resorted to further bariatric measures. CONCLUSION IGB leads to weight loss among most patients, but it does not appear to fulfill patients' expectations. Further, the initial weight loss is not sustainable over time.
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Affiliation(s)
- Aline El Haddad
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammad O Rammal
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Assaad Soweid
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ala I Shararra
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fady Daniel
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mahmoud A Rahal
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yasser Shaib
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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