BioEnterics Intragastric Balloon Research Articles

Endoscopic bariatric surgery for adults with overweight and obesity: a systematic review and network meta-analysis.

Endoscopic bariatric surgery (EBS) is a new treatment for obesity. We compared the efficacy, safety, and probability of metabolic complications of different EBSs with laparoscopic sleeve gastrectomy (LSG). This systematic review and network meta-analysis (NMA) included searches of PubMed, Web of Science, and the Cochrane Library from January 1, 2017, to December 27, 2022, to find comparative trials of EBS procedures and EBS with LSG. We performed a frequentist model NMA to summarize the evidence and ranked the interventions according to SUCRA scores. The search for this NMA yielded 14,160 articles, of which 18 eligible trials recruited 766,135 participants for procedures including LSG, endoscopic sleeve gastroplasty (ESG), nonadjustable intragastric balloon (NIB), BioEnterics Intragastric Balloon (BIB), and adjustable intragastric balloon (AIB). Definitive evidence suggests that LSG is most effective for weight reduction. Compared with LSG, NIB, SMD = -0.49 [95% CI -0.79, -0.18]; AIB, SMD = -0.41 [95% CI -0.76, -0.06] and ESG, SMD = -0.31 [95% CI -0.33, -0.29] in the index of percentage total weight loss under six months. In terms of safety outcomes, ESG had the lowest incidence of adverse events; the order of the observed incidence of adverse events from small to large was ESG, NIB, AIB, LSG, and BIB. ESG is an effective and safe minimally invasive surgical method for people with overweight and obesity. Its 12-month effect is better than that of NIB, and its influence on lipid metabolism makes it more protective of the cardiovascular system and liver. CRD42022375343.

Effects of Bioactive Dietary Components on Changes in Lipid and Liver Parameters in Women after Bariatric Surgery and Procedures.

Excess adipose tissue, as well as its distribution, correlates strongly with disorders of lipid and liver parameters and chronic inflammation. The pathophysiology of metabolic diseases caused by obesity is associated with the dysfunction of visceral adipose tissue. Effective and alternative interventions such as the Bioenteric Intragastric Balloon and bariatric surgeries such as the Roux-en-Y gastric bypass. The aim of this study was to assess the effect of modifying the recommended standard weight loss diet after bariatric surgery and procedures on reducing chronic inflammation in overweight patients. In the study, bioactive anti-inflammatory dietary components were used supportively. Changes in the concentrations of lipid parameters, liver parameters, antioxidant enzymes, cytokines, and chemokines were demonstrated. The enrichment of the diet, after bariatric surgery, with the addition of n-3 EFAs(Essential Fatty Acids), bioflavonoids, vitamins, and synbiotics resulted in higher weight losses in the patients in the study with a simultaneous reduction in parameters indicating liver dysfunction.

Sex difference in the safety and efficacy of bariatric procedures: a systematic review and meta-analysis.

With the prevalence of obesity alarmingly increasing, it is of primary interest to identify those factors predicting the success of anti-obesity therapeutic strategies currently adopted in clinical practice, and in particular, those of bariatric procedures showing the greatest success in terms of weight loss and maintenance in both the short and long term. Given sex-related differences in psychosocial status, hormonal homeostasis, and body fat distribution, it is likely that the response to different weight management strategies differs by sex. The objective was to elucidate the effect of sex on different bariatric procedures' efficacy and safety outcomes. Searches of PubMed, Cochrane, and Embase databases were performed, followed by hand-searching of reference lists from all relevant articles. We included all the studies evaluating the effect of bariatric procedures on body mass index loss (BMIL), and/or percentage excess weight loss (%EWL), and/or percentage excess body mass index loss, and/or percentage of responders, and/or short-/long-term complications and co-morbidity resolution, broken down by sex. Twenty-seven studies with a total of 114,919 patients were included. Men were more likely to achieve greater BMIL, consistent with higher male baseline BMI, and women were 2.87 times more likely to be classified as weight responders (95% confidence interval [CI]: 1.90-4.34), as well as to perform better in terms of %EWL (95% CI: .13-.54). Upon subgroup analysis based on bariatric procedure, women were more likely to be successful in terms of %EWL upon bioenteric intragastric balloon (BIB) placement (.72, 95% CI: .42-1.02). There was no sex difference regarding investigated co-morbidity resolution (hypertension, diabetes, and obstructive sleep apnea syndrome) or occurrence of short-term complications, whereas women were more likely to develop long-term complications, with an odds ratio of 1.97 (95% CI: 1.57-2.49). Sex does not have a clear effect on efficacy outcomes of bariatric procedures. Differentiating by procedure, BIB may be more effective in women, although results are discordant based on the weight loss outcome considered. If the short-term postoperative complication rate is similar across both sexes, long-term complications occur more frequently in women. To clarify the real effect of sex on bariatric procedure-derived health benefits, it is crucial to report sex-stratified results in future studies, as well as evaluate body composition changes that go beyond simple body weight reduction.

A Hub and Spoke Learning Program in Bariatric Surgery in a Small Region of Italy.

BackgroundMetabolic and bariatric surgery (BS) are considered life-changing and life-saving treatments for obese patients. The Italian Society of Obesity Surgery (SICOB) requires at least 25 operations per year to achieve the standard of care in the field. Despite the increasing need to treat obese patients, some small southern regions of Italy, such as Molise, do not have enough experience in bariatric procedures to be allowed to perform them. Therefore, our aim was to run a Hub and Spoke Program with a referral center in BS to treat obese patients and provide a proper learning curve in BS in Molise.MethodsIn 2020, the “A. Cardarelli Hospital” in Campobasso, Molise, started a formal “Learning Model of Hub and Spoke Collaboration” with the Hub center “Ospedale Del Mare”, Naples. A multidisciplinary approach was achieved. Patients were supervised and operated under the supervision and tutoring of the referral center. We retrospectively reviewed our prospectively collected database from February 2020 to August 2021 in order to analyze the safety and effectiveness of our learning program.ResultsIn total, 13 (3 men and 10 women) patients underwent BS with the mean age of 47.08 years and a presurgery BMI of 41.79. Seven (53.84%) patients were the American Society of Anesthesiologist (ASA) II, and 6 (46.16%) patients were ASA III. Twelve (92.31%) procedures were laparoscopic sleeve gastrectomies, 1 (7.69%) patient underwent endoscopic BioEnterics Intragastric Balloon (BIB) placement. One (8.33%) sleeve gastrectomy was associated to gastric band removal. Mean surgical time was 110.14 ± 23.54 min. The mean length of stay was 4.07 ± 2.40 days. No Clavien-Dindo ≥ III and mortality were reported. The follow-up program showed a mean decrease of 11.82 in terms of body mass index (BMI) value. The last 5 procedures were performed by the whole equips from “A. Cardarelli” under external tutoring without any impact on complication rate.ConclusionThe setup of a proper Hub and Spoke Program may allow to perform BS to provide the standard of care. This approach may reduce health costs and related patient migration.

Endoscopic intragastric balloon therapy for 15 years in Japan: Results of nationwide surveys.

Endoscopic intragastric balloon (IGB) placement has been performed in Japan since 2004. The nationwide surveys were repeatedly carried out to confirm the effectiveness and safety of IGB in Japan. We herein present the accumulated results. Twenty-six Japanese endoscopists personally imported products of the BioEnterics Intragastric Balloon (BIB)/Orbera system after completing the training courses in Japan. Mail surveys were posted to them every 2 years from 2010. This study included the accumulated data of the six surveys, and excluded data from non-Japanese patients and the Orbera365 data. Between 2004 and 2019, 399 obese Japanese patients underwent IGB treatment using the BIB/Orbera system. The incidence rates of early removal of IGB within 1week and complications due to IGB were 4.8% and 6.1%, respectively. The average percent excess weight loss (%EWL) and percent total weight loss (%TWL) at IGB removal were 46.6% and 11.5%, and successful weight loss, defined as %EWL ≥ 25% or %TWL ≥ 10%, was achieved in 65.6% or 54.5% of the patients, respectively. Multivariate analyses revealed that older age and larger saline filling volume were independent predictors of successful weight loss. At 1year after IGB removal, successful weight loss defined by the %EWL and %TWL was maintained in 44.7% and 34.1% of the patients, respectively. IGB therapy using the BIB/Orbera system has been safely and effectively performed in Japan. The successful weight loss may be associated with older age and larger saline filling volume.

The Effect of Noninvasive Bariatric Surgery on the Levels of Certain Adipokines and Atherosclerosis Risk Factors in Patients with Metabolic Syndrome

Objective: Besides glucose intolerance, dyslipidemia, and hypertension, visceral obesity is one of the most important atherogenic pathological factors in patients with metabolic syndrome (MetS). The aim of this study is to examine whether weight loss following BioEnterics Intragastric Balloon (BIB-system) therapy affects adipokine concentration and atherosclerosis risk factor profile in patients with MetS.Methods: The study group comprised 30 patients (17 female, BMI = 38.5 ± 8.6 kg/m2; 13 male, BMI = 43.3 ± 7 kg/m2) with MetS qualified to BIB-system therapy. The control group included 18 age matched healthy volunteers (10 female, BMI = 23.3 ± 2.8 kg/m2 and eight male, BMI = 27.3 ± 0.9 kg/m2). Biochemical analyses of blood samples and anthropometric measurements were conducted, before and after six-month BIB system therapy.Results: BIB therapy resulted in a significant drop in body weight, and body fat percentage, and in BMI, VAI, WHtR, BAI, TG, glucose, hsCRP, and leptin levels. In addition Tc/HDL, LDL/HDL, TG/HDL, and leptin/adiponectin ratios fell significantly, and adiponectin concentration increased. All anthropometric parameters apart from Tc and hsCRP, were significantly different post-therapy compared to healthy controls. The therapy induced downregulation of hsCRP which was positively correlated with the reduction in body weight, BMI and BAI. The decrease in leptin concentration correlated positively with the fall in total cholesterol and body weight. The fall in leptin/adiponectin ratio positively correlated with the downregulation of BAI and body fat.Conclusion: BIB therapy appears to have beneficial effects on MetS. This is indicated by amelioration of the pro-inflammatory status related to obesity, demonstrated by an improved lipid profile significant downregulation of hsCRP concentration following therapy.

The Bioenteric Intragastric Balloon (BIB) as a Management for Treatment- Resistant Obesity: The Lebanese Experience

The Bioenteric Intragastric Balloon (BIB) as a Management for Treatment- Resistant Obesity: The Lebanese Experience

Propofol Sedation for Intragastric Balloon Removal: Looking for the Optimal Body Weight Descriptor.

Sedation is considered as a prerequisite for the safe and effective conclusion of Bioenterics Intragastric Balloon (BIB) removal (our aim was to ascertain the most appropriate body size scalars for propofol dosing and assess the efficacy and safety of a sedative approach involving the infusion of propofol for BIB removal. Retrospective analysis of prospectively collected data of 414 adults scheduled to undergo BIB removal. Our primary end-point was to delineate the relationship between propofol dosing and body size descriptors namely body mass index, total body weight, ideal body weight, lean body weight (LBW) and normalized LBW. Sedative efficacy of this practice, anesthesia or procedural-related adverse events and patients' satisfaction level served as secondary outcome parameters. Propofol dose (mg/kg/min) was positively related to all body weight descriptors in an important manner (p < 0.001). Among them, LBW was singled out as the body size descriptor to best capture the appropriate needs of propofol (R2= 0.432; p= 0.000). Hypoxemia, hemodynamic compromise, gastroesophageal reflux or moderate movement occurred rarely; all of them were readily reversed. The majority of participants had no recollection of the noxious phase of the procedure or declared at least adequately satisfied from the experience (84% and 95%, respectively). LBW could serve as relatively more accurate dosing scalar compared to actual or ideal body weight descriptors, in obese individuals undergoing BIB removal under propofol sedation. The conscious/deep sedation based on propofol infusion emerges as a feasible and efficacious sedative approach for this procedure.

Efficacy and Safety of Intragastric Balloon Placements in 1600 Case, an Experience from the Middle East.

Intragastric balloons are used as a treatment for obesity. Much of the data collected on balloons had been in the context of clinical trials in academic medical centers or as a bridge to bariatric surgery in obesity centers. The aim of this study was to investigate the efficacy and safety of balloon treatment in private practice. This is an interventional study. The study included 1600 patients. The study was conducted at the ElKatib Hospital. This was a retrospective analysis of 6-month weight loss data and balloon-related complications of patients referred to a private center for obesity treatment. The assessment was carried out by obtaining full patients' history (personal history, present illness, and previous drug history and operations). Laboratory work was done in the form of CBC, blood sugar, and viral markers. Bioenterics Intragastric Balloon (BIB) silicone balloon was used, filled with saline plus methylene blue dye with a volume ranging from 400 to 700ml. The gained measures were analyzed by using SPSS program, and paired t test and chi-square test were used to compare between groups. A total of 1600 patients were included (368 male (23%) and 1232 female (77%)) with mean age 34.1 ± 10.354, mean body weight 112.45 ± 26.24, and mean body mass index (BMI) 40.32 ± 8.17. There were 46 patients younger than 18years and 12 patients older than 60years. There were 109 patients with a BMI ranging from 25 to < 35 and 737 patients with a BMI ≥ 40kg/m2. A total of 1567 patients who attended weight consultation had a mean weight loss 17.35 ± 11.07 from intragastric balloon implantation. Thirty-three patients from the total sample were not weighted after the removal of the balloon (dropped out). Percentage excess weight loss (% EWL) = 100% × (baseline absolute weight (AW)-last weight)/(baseline AW-initial body weight (IBW)) was found, and weight loss of more than 10% was considered significant. About 49.3% of patients showed significant weight loss > 10%, 24.7% of patients showed weight loss > 20%, while 26% of patients showed no significant weight loss < 10%. Intragastric balloons on their own, with an intensive lifestyle program and supportive consultations, resulted in safe and short-term substantial weight loss, and may fill the therapeutic gap between pharmacotherapy and surgery.

Quality of life of obese patients after treatment with the insertion of intra-gastric balloon versus Atkins diet in Sulaimani Governorate, Kurdistan Region, Iraq.

BackgroundHealth-related quality of life of obese patients, before and after weight loss by insertion of BioEnterics Intra-gastric Balloon is studied widely. But the quality of life not related to comorbidity of the obese patients like mood, satisfaction with relationships, achieved goals, self-concepts, and self-perceived ability to cope with one's daily life is not studied on a wide scale.AimTo evaluates the effect of the obesity on different aspects of life, and to evaluate the influence of weight loss after BIB insertion or Atkins diet on the quality of life regarding mood, satisfaction with relationships, achieved goals, self-concepts, and self-perceived ability to cope with one's daily life.Patients, materials, and methodsA prospective randomized study, from a total of 180 patients, 80 patients were selected to enroll in the work, over a period of 4 years from 2008 to 2012 in Hatwan private hospital and the private clinic, the closing date was 1st January 2013.Approval for the current work was obtained from the Ethics Committee of University, College of Medicine. The work has been reported in line with the STROCSS criteria. The study was designed as a descriptive longitudinal study conducted on 40 patients who underwent intra-gastric balloon insertion compared to a matched group (for age, BMI) of 40 patients on Atkin's diet.ResultsTwo comparable groups of obese patients were studied, each group consists of 40 female patients, mean age in group A was 27 years (20–39 years) with mean body weight 90 kg (80–100) and mean body mass index 36 (31–39.9) who were treated with insertion of BIB. While mean age in group B was 29 years (20–39 years) with mean body weight 91 kg (80–102) and mean body mass index 36.5 (31–39.9). Statistically important changes occurred in the quality of life of the patients after either method of treatments to different degrees (p-value 0.005917).ConclusionThe patients lost more weight after insertion of intra-gastric balloon up to 35 kg of body weight, while the patients on Atkins diet lost up to 20 kg body weight. This results in statistically significant improvement of most aspects of QOL. Especially in Feeling happier, more satisfaction with the new body image, Improvement of self-esteem, encouraged for more regular exercises, less nervous, embarrassed less by unimportant matters, have less negative thoughts, and the craving of foods decreased remarkably.

Assessment of the Effect of Dietary Modifications and Bioenteric Intragastric Balloon Treatment on the Changes of Some Morphological and Biochemical Parameters in Obese Patients

Obesity is the most common disease of affluence of the XXI century. According to WHO (World Health Organization), it is defined as a chronic metabolic disorder manifested by excessive accumulation of adipose tissue with high tendency for familial occurrence. According to WHO, obesity reaches epidemic proportions in many countries. High BMI (Body Mass Index) correlates with coexisting diseases. Traditional dietetic treatment often does not bring any results. A form of conservative (non-surgical) support for patients in fighting with obesity is the reduction of stomach volume by bioenteric intragastric balloon (BIB) treatment. The aim of the work was to develop a diet with anti-inflammatory properties, well-tolerated by the patients after BIB treatment. An American diet was modified by changing the composition of fatty acids, increasing anti-oxidative potential and adding synbiotics for patients treated with BIB. Chemical analysis of reconstructed food ratios of recommended diet was performed, analysing the content of micronutrients, composition of fatty acids, antioxidative capacity, reducing power and the content of polyphenols. Improvement in anthropometric measurement results and satisfying body weight loss were obtained, while preserving fat-free body mass. Improvement in the parameters of lipid metabolism was also observed, that is, decrease in total CH (cholesterol) and TG (triglycerides), and normalized concentration of HDL (high density lipoproteins) and LDL (low density lipoproteins) fractions. Reduced concentration of glucose in blood and lower blood pressure was also noted. Performed study confirms the effectiveness of complex treatment with BIB and properly adjusted individualized diet. Observations and own experience allow to deduce that patients who resign from systematic contact with a dietician cannot maintain reduced body weight. Abandoning previous habits is the only way to maintain the effect of weight loss. Most importantly, the change in patients’ awareness and consequent behaviour in the future are crucial. Even though genes may contribute to obesity, environmental factors mainly determine the possibility of the disease to occur. Therefore, the change of patients’ lifestyle after body weight reduction will decide on their fate.

Air-Filled versus Water-Filled Intragastric Balloon: A Comparative Retrospective Study

Introduction: The positioning of an intragastric balloon (saline or air filled) has been developed as temporary and reversible therapeutic option for treatment of obesity.The purpose of this study is to compare these two devices in terms of weight reduction parameters and patients'tolerance. The research question of this study was as follows: Is there a difference in the BMI reduction and the rate of premature withdrawal between the two groups of patients? Methods: The participants of this study were patients who gone through gastric balloon procedure. The independent variables included were: the gender, the age, the type of gastric balloon (saline or air), and the initial body mass index (BMI). The established post procedure period was six months from the time of gastric balloon insertion. The outcome variables were the mean BMI loss after six monthsfrom the insertion and the rate of premature withdrawal due to intolerance.Quantitative method was applied using comparative design. A total of 113 patients: group A (87 patients) managed with saline-filled Bioenterics Intragastric Balloon -BIB, and group B (26 patients) managed with air-filled Endobag-Heliosphere Balloon?.Mean initial BMI was ( 37.96; SD6.17 Group A & 34.05; SD 5.89 for Group B) while the mean age ( 32.13;SD 8.71 GroupA & 37.42; SD10.29 for Group B); all of them were followed up in the same clinic with similar dietary instructions.Most of the participants (75.2%) were female.The air balloon was air-filled with 600 ml while the saline- filled balloon was filled with 500 ml of saline and 10 ml of methylene blue. Results: The BMI loss following the saline-filled balloon procedure ( M = 3.73, SD = 3.03) and the airfilled balloon procedure ( M = 1.75, SD = 1,81) with a significant difference (p< .001).Premature removal of the balloon was reported in 16 cases (14 for saline -filled balloon and 2 for air-filled ballon);and all the balloons were removed within one month from the insertion date due to vomiting, nausea and abdominal pain .There was no statistical significant difference in the mean score of withdrawal between the two groups. (p=.21 > .05). Conclusion: patients with saline-filled balloon procedure (M = 4.66, SD = 4.75) tend to lose weight (on average) significantly more than patient with air-filled balloon procedure (p < .001).On the other hand, the difference between the rates of premature withdrawal between the two groups was insignificant (P=0.21).1033_A Figure 1 No Caption available.1033_B Figure 2 No Caption available.1033_C Figure 3 No Caption available.

Improving Weight Loss by Combination of Two Temporary Antiobesity Treatments.

It is generally accepted that the efficacy with an intragastric balloon decreases after the first 4months of treatment. Aim of this study is to evaluate if the association of a very low-calorie ketogenic diet (VLCKD) can improve the results in terms of weight loss parameters and co-morbidities, as compared to usually prescribed low-calorie diet (LCD). For the present study (January 2016-June 2017), 80 patients (20M/60F, mean age 37.8 ± 6.1years; excess weight 56 ± 10kg; mean BMI 37.2 ± 3.8kg/m2) underwent Orbera positioning. After 4months, they were randomized into two groups according to the type of treatment: group A (Bioenterics intragastric balloon - Orbera + VLCKD) (n = 40), and group B (Orbera + LCD) (n = 40). All patients completed the study with good adherence to diet therapy treatment allocation. After the 6-month treatment period, at time of Orbera removal, mean weight loss was 19kg and 12kg in groups A and B respectively (p < 0.05). Mean BMI was 28.9 ± 2.8 and 31.6 ± 3.1kg/m2 (p < 0.05), and %EWL was 33.1 ± 3.3 and 21.1 ± 2.9 (p < 0.05) in groups A and B respectively. During the last 2months in group A, the mean weight loss was 8kg, while in Group B, the main weight loss was 3kg (p < 0.001). The VLCKD treatment induced a more significant reduction of major comorbidities related to metabolic syndrome. This study clearly indicates the efficacy of the prescription of very low-calorie ketogenic diet improving the efficacy of intragastric balloon positioning.

Obesity treatment by Bioenterics intragastric balloon: Iranian results.

We studied the effectiveness, tolerability and safety of Bioenteric Intragastric Balloon (BIB) for treatment of obesity in Iranian population. 52 patients (46 female (88.5%), mean age: 35.5 ±10, mean body weight: 107.6±25.4 kg) referred to two major training hospitals in Tehran, Iran, after evaluation by a multidisciplinary team, underwent endoscopic BIB placement under unconscious sedation. BIB was removed after 6 months and patients were discharged with drug therapy and 1000 kcal diet. Weight and Body Mass Index (BMI) were assessed at baseline, 6 months and 1 year after BIB insertion. The mean weight and BMI at baseline were 107.6±25.4 kg and 39.4±7.9 kg/m2; 6 months after balloon placement, they were 88.7±21.9 kg and 32.5±7.4 kg and 6 months after balloon removal, they were 93.4±21.9kg and 34.85±8.2 kg/m2 respectively. The weight decline was statistically significant throughout the study and follow up with p value <0.001. The most frequent side effects were nausea and vomiting which were resolved in the majority of cases by one week. No major complications, such as death, gastric obstruction, gastric or esophageal perforation, or balloon displacement occurred in our study. BIB is a safe, effective and well-tolerated treatment of obesity, but its effects are temporary, so it should be accompanied and followed by other methods to achieve sustained weight reduction.

Displacement of the Intragastric Balloon from the Fundus to the Antrum Results in Enhanced Weight Loss.

The BioEnterics Intragastric Balloon [BIB] is a reliable, non-invasive technique to manage obesity for subjects who refuse or are unsuitable for bariatric surgery. In a prior study, BIB placed in the antrum [A] was found to have significantly better results on weight loss in relation to that in fundus [F], but many balloons initially placed in the F were eventually found in the A. The aim of the present analysis was to evaluate whether the balloon position [firmly in F, firmly in A, or transient from F to A [FA]] influences the 3- and 6-month weight loss. Six hundred sixty-eight patients that underwent successful BIB treatment were assigned into three groups: group F [n = 354], group A [n = 159], and group AF [n = 155]. Weight loss parameters were recorded and analyzed at 3 and 6months. In all three groups, there was a significant, progressive reduction of BMI at 3 and 6months. At 6months, BMI reduction between groups F and A, and F and FA [p = 0.001] and groups A and FA [p = 0.018] was prominent. The position of the BIB affects its effectiveness: better results when antrum is involved. This observation seems to give a great perspective to newly established gastric space-occupying devices, which aim to have a compartment constantly present in the antrum. However, further studies have to be performed in order to validate the results and more importantly to clarify the mechanisms implied.

Increased Proliferative Activity Accompanies the Local Inflammatory Response of Gastric Mucosa After Intragastric Balloon Insertion

The use of BioEnterics intragastric balloon (BIB) is progressively increasing, owing to the fact that morbid obesity becomes a global epidemic together with risks of bariatric surgery. Yet, the possible local BIB effect on gastric mucosa is not clearly elucidated. The aim of the current study was to assess the histological changes occurring in the gastric mucosa post-BIB insertion. Gastric mucosa biopsy was obtained from 87 cases of morbid obesity both pre-BIB and 6months post-BIB insertion to compare the local changes by histological and immunohistochemical analysis. An inflammatory reaction was detected in the post-BIB mucosa which displayed a positive CD20, CD3 (p<0.05), and the proliferation index (Ki67) increased significantly compared with that of the pre-BIB cases. The Ki67 index showed a significant positive correlation with CD20 and CD3 immunoexpression in the post-BIB gastric mucosae. Our results demonstrated a possible increase in the gastric proliferative activity after BIB insertion accompanied with a remarkable local inflammatory reaction. Although these findings may be reactive and transient, endoscopic follow-up is recommended for early detection of further pathological changes.

BioEnterics Intragastric Balloon (BIB) versus Spatz Adjustable Balloon System (ABS): Our experience in the elderly

The BioEnterics Intragastric Balloon (BIB) and the Spatz Adjustable Balloon System (ABS) are in fact recommended for weight reduction as a bridge to bariatric surgery. We retrospected studied patients with body mass index (BMI) and age ranges of 37–46 and 70–80 years, respectively, who had undergone BIB from January 2010 to July 2012 and prospected studied patients who had undergone Spatz balloon from July 2012 to August 2014. The aim of this study is to compare BIB and Spatz in terms of weight loss, complications, and maintenance of weight after removal. For both procedures, the median weight loss was 20 ± 3 kg, median BMI at the end of the therapy was 32 ± 2, and no severe complication occurred.

Telomere length elongation after weight loss intervention in obese adults.

Telomeres may be considered markers of biological aging, shorter telomere length is associated with some age-related diseases; in several studies short telomere length has also been associated to obesity in adults and adolescents. However the relationship between telomere complex functions and obesity is still not clear. Aim of the study was to assess telomere length (TL) in adults' obese subjects before and after weight loss obtained by placement of bioenteric intragastric balloon (BIB) for 6months. We enrolled 42 obese subjects before and after BIB placement as weight loss intervention. Blood samples were collected in order to obtain DNA from leukocyte to measure TL by quantitative PCR. Data were analyzed only in 37 subjects with complete data; all presented important body weight loss (124.06±26.7 vs 105.40±23.14, p<0.001) and more interesting they presented a significant increase in TL (3.58±0.83 vs 5.61±3.29, p<0.001). Moreover we observed a significant positive correlation between TL elongation and weight loss (r=0.44, p=0.007) as well as an inverse correlation between TL at baseline and TL elongation (r=-0.35, p=0.03).The predictors of TL elongation were once again weight loss and short TL at baseline (respectively p=0.007 and p=0.003). Our study shows that weight loss is associated to telomere lengthening in a positive correlation: the greater weight loss the greater telomere lengthening; moreover telomere lengthening is more significant in those subjects with shortest telomeres at baseline.

Morbid Obesity: treatment with Bioenterics Intragastric Balloon (BIB), psychological and nursing care: our experience.

Obesity is considered a chronic disease, difficult to treat, and is the first cause of death in the world that is predictable. The surgical approach is limited to patients with severe obesity but there is an intermediate group who are not candidates for immediate surgery. The BioEnterics Intragastric Balloon (BIB) is recommended for weight reduction as a bridge to bariatric surgery.All patients in the study underwent a psychological evaluation prior to placement of the BIB.

What could happen if you insert a BioEnterics intragastric balloon after sleeve gastrectomy?

A 49-year-old previously healthy female patient with a body mass index (BMI) of 41 kg/m had undergone an SG 3 years before presentation to our hospital. She had lost 30 kg but then regained 10 kg because of increased food intake, and she had failed to maintain all conservative measures. Her treating physician has decided to insert an intragastric balloon with a capacity of 300 mL until tension on the gastric wall could be observed. She was referred to us 2 hours later as she experienced abdominal pain, retching, and hematemesis. Her vital signs and abdominal examination were normal. Therefore, the balloon was removed; however, a gastric mucosal tear was observed, but it went unrecognized as a full-thickness tear at this time. The patient was admitted for observation. Two hours later, she developed tachycardia, (heart rate [HR] 1⁄4 110 beats/ min), hematemesis, and abdominal distention. A standing abdominal film revealed a huge amount of air under the diaphragm (Fig. 1). Thus, a decision was made to perform