Intragastric Balloon Research Articles

Mass effect of an intragastric balloon leading to hydroureteronephrosis

Mass effect of an intragastric balloon leading to hydroureteronephrosis

Predictors of inadequate weight loss after laparoscopic sleeve gastrectomy

Background and aim Laparoscopic sleeve gastrectomy (LSG) has become a popular procedure in the bariatric field in Egypt. However, little is known regarding the prevalence and risk factors of inadequate weight loss (IWL) following this procedure. Thus, we conducted this study to estimate the prevalence of IWL and its predictors after LSG. Patients and methods The data of consecutive 118 obese adults who underwent LSG were reviewed. The collected data included preoperative and intraoperative variables. Our primary outcome was to estimate the prevalence of IWL or failure after LSG (percent of excess weight loss <50), while the secondary outcomes included identifying risk factors or predictors for this unsatisfactory outcome. Results Failure was encountered in 34 patients out of the included 118 cases. Therefore, the prevalence of failure was 28.81%. Older age and higher basal BMI were associated with failure. Sex distribution was comparable between success and failure groups. Obesity-related comorbidities showed no significant difference between the same groups, apart from obstructive sleep apnea, which showed a significant rise in the failure group. Additionally, operative time, bougie size, and distance from pylorus did not show any significant differences between the two groups. Conclusion Older age, higher basal BMI, obstructive sleep apnea, increased number of obesity-related comorbidities, and previous gastric balloon are significant risk factors for IWL following LSG. Another bariatric procedure (mainly malabsorptive) should be offered for these high-risk groups.

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.

Trends in the Utilization of Intragastric Balloons: a 5-Year Analysis of the MBSAQIP Registry.

The use of intragastric balloons (IGBs) for the treatment of obesity was approved by the US Food and Drug Administration in 2015. This study aims to characterize preoperative factors and outcomes of patients undergoing IGB therapy compared to bariatric surgery (non-IGB) and evaluate 5-year trends in IGB use. A retrospective cohort study was performed by extracting data from the MBSAQIP registry between 2015 and 2019. All non-IGB and IGB procedures were included while revisional and emergency surgeries were excluded. Multivariable logistic regression analysis was used to determine independent predictors of patient selection for IGB therapy. Of 652,927 patients identified, only 2910 (0.4%) underwent IGB therapy. Patients who underwent IGB therapy were older (46.7 ± 11.4years vs 44.4 ± 12.0years; p < 0.0001), had lower BMI at baseline (37.0 ± 6.2kg/m2 vs 45.3 ± 7.8kg/m2; p < 0.0001), and were overall healthier with fewer comorbidities and better functional status. The rate of early nonoperative reintervention was higher in the IGB cohort (7.7% vs 1.1%; p < 0.0001). Age was the only significant predictor of selection for IGB therapy (OR 1.32; 95% CI 1.24-1.37; p < 0.0001). The number of IGB procedures reported between 2016 and 2019 declined significantly (953 (0.62%) vs 418 (0.25%); p < 0.0001). Appropriate indications for IGBs appear to be increasingly limited. The ongoing role of IGBs in the treatment of obesity is unclear given the safety and efficacy of modern bariatric surgery and new pharmacological agents for weight loss.

Vücut Kitle İndeksi değerlerine göre ayarlanabilir intragastrik balon kullanım sonuçları

Aim: In our study, it was aimed to compare the results of adjustable intragastric balloons in patients according to body mass index.&#x0D; Material and Method: We recorded the data of 82 patients that we performed AIGB procedure in the last four years. During the initial implantation of the balloon, inflating was performed with 300-350 cc saline and methylene blue. Body mass index values and excess weight loss ratios of the patients at the time of the balloon removal were noted. Patients' complaints and complications arising after balloon application or additional inflation were reported.&#x0D; Results: It was determined that there was a statistically significant decrease between weight, BMI, and EWL values measured at the 4th, 8th, and 12th months after the first application was performed (p

Impact of Vagotomy on Postoperative Weight Loss, Alimentary Intake, and Enterohormone Secretion After Bariatric Surgery in Experimental Translational Models.

Obesity may be treated by bariatric procedures and is related to enterohormone release modulation. Nevertheless, a majority of commonly used surgical procedures have a significant impact on vagus nerve function by breaking the connections with its gastric branches. In the case of an intragastric balloon (BAL), this interaction is unclear. However, BAL-induced weight reduction is not long-lasting. Interestingly, this method has not been used in combination with vagotomy (VAG). Thus, we evaluated, for the first time, the short- and long-term effects of combined BAL and VAG using the animal-based translational model and compared these effects with sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Wistar rats were fed a high-calorie diet for 8weeks to induce obesity before SG, RYGB, BAL + / - VAG. Animals' weight and eating behaviors were monitored weekly. After 90days, serum samples were collected to evaluate postprandial and fasting GLP-1, GIP, PYY, ghrelin, glucagon, insulin, leptin, and pancreatic polypeptide concentrations by fluorescent assay. VAG, SG, RYGB, and BAL + VAG significantly reduced body weight 30 and 90days after surgery. BAL alone induced temporal weight reduction observed after 30days, reversed after 90days. Calories intake was reduced at the first half of the observation period in all groups. Fluid intake was reduced in all groups except SG and BAL. Enterohormone profile for BAL + VAG was comparable to SG and RYGB but not BAL. VAG and BAL + VAG but not BAL alone maintain weight reduction, alimentary intake changes, and enterohormone release after long-term observation. VAG may improve the effectiveness of bariatric procedures for obesity treatment in clinical practice.

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

BackgroundAn 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.MethodsIn 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.ResultsIntragastric 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.ConclusionA 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.

Spontaneous Intragastric Balloon Hyperinflation Is Probably Due to Microbial Overgrowth of the Filling Liquid.

Spontaneous Intragastric Balloon Hyperinflation Is Probably Due to Microbial Overgrowth of the Filling Liquid.

Enchanced preoperative rehabilitation as part of the complex perioperative rehabilitation of patients with super-obesity and obstructive sleep apnea syndrome (clinical outlook)

Obesity is a global social and economic problem. The bariatric surgery is a most effective treatment for obesity. The presented clinical case demonstrates the usage of principles of enchanced perioperative rehabilitation for the preoperative preparation of a patient with super obesity and with severe obstructive sleep apnea and alveolar hypoventilation syndrome.A 54-year-old patient was hospitalized with complaints of obesity, impossibility of persistent weight loss conservatively, severe daytime sleepiness, frequent nocturnal awakenings (up to 8 times per night). The patient’s weight was 230 kg with a height of 157 cm (BMI 93.5 kg / m2). The examination revealed a syndrome of sleep apnea of mixed genesis of extremely severe degree, chronic night hypoxemia of an extremely severe degree. Preoperative preparation was performed in accordance with the program of enchanced perioperative rehabilitation. The duration of preoperative preparation was 19 days; weight loss — 40 kg (%WL -17,4), compensation of comorbidities was achieved as well. After that the patient underwent a laparoscopic sleeve gastrectomy. There were no complications in the postoperative period. Length of postoperative hospital stay was 6 days. At follow-up examination one year after surgery, body weight dropped from 230 to 153 kg (% WL-33.5), a significant improvement of the quality of life was achieved.The enchanced perioperative rehabilitation program can be successfully used as an effective method for preoperartive preparation of the patients with morbid obesity in combination with severe obstructive sleep apnea syndrome.and obesity hypoventilation. It can be a reasonable alternative to the standard program with preoperative intragastric balloon treatment. The use of this technique allows to increase the effectiveness of treatment of these high-risk patients, as well as to reduce the risk of perioperative complications.

The current status and future perspectives of bariatric and metabolic surgery in the management of obesity and its co-morbidities

Bariatric-metabolic surgery (BMS) has the potential of decreasing body weight and improving obesity-related metabolic syndrome by restricting food intake and malabsorption. Laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass, adjustable gastric banding, biliopancreatic diversion with duodenal switch are four major BMS procedures. Sleeve plus surgery, one-anastomosis gastric bypass, intragastric balloon and endoscopic surgery are also arising and gaining popularity due to their specific efficacy. Currently, BMS is now experiencing an era with deeply integrated interdisciplinarity, optimizing and innovating of surgeries and well-illustrated clinical efficacy, as a result, more obese patients would benefit from BMS.

Extrapancreatic Advanced Endoscopic Interventions.

As the field of interventional endoscopy advances, conditions that were once treated with surgery are increasingly being treated with advanced endoscopy. Endoscopy is now used for treatment of achalasia, bariatric procedures for obesity; resection of early-stage malignancies in the gastrointestinal tract; and placement of lumen-apposing metal stents in the treatment of biliary obstruction, gastric outlet obstruction, cholecystitis, and drainage of nonpancreatic-related fluid collections or abscesses. Knowledge of the novel terminology, procedural details, expected postintervention imaging findings, and potential complications is vital for radiologists because these procedures are rapidly becoming more mainstream in daily practice. These procedures include peroral endoscopic myotomy for the treatment of achalasia and other esophageal motility disorders; endoscopic sleeve gastroplasty and placement of an intragastric balloon for weight loss; endoscopic submucosal dissection in the resection of tumors of the gastrointestinal tract; and therapeutic endoscopic-guided procedures for the treatment of biliary obstruction, gastric outlet obstruction, acute cholecystitis, and drainage of nonpancreatically related fluid collections. Patients benefit from these minimally invasive procedures, with potential improvement in morbidity and mortality rates, decreased length of hospital stay, and decreased health care costs when compared with the surgical alternative. Complications of these procedures include leaks or perforations, infections or abscesses, fistulas, and occlusion and migration of stents. An invited commentary by Pisipati and Pannala is available online. ©RSNA, 2022.

Endoscopic management of small bowel obstruction caused by intragastric balloon using antegrade single-balloon enteroscopy.

A 44-year old woman with type 2 diabetes mellitus who underwent intragastric balloon (Spatz3) insertion 1 year ago presented with acute abdominal pain for 3 days. Abdominal examination showed mild tenderness at the epigastrium. Laboratory investigation showed a white blood cell count of 12,630 /mm3. An abdominal computed tomography (CT) scan revealed a distally migrated intragastric balloon in the mid-jejunum causing a small bowel obstruction ([Fig. 1]). After a discussion regarding treatment options, she decided to undergo endoscopic removal using antegrade single balloon-assisted enteroscopy.

The first survey addressing patients with BMI over 50: a survey of 789 bariatric surgeons

BackgroundBariatric surgery in patients with BMI over 50 kg/m2 is a challenging task. The aim of this study was to address main issues regarding perioperative management of these patients by using a worldwide survey.MethodsAn online 48-item questionnaire-based survey on perioperative management of patients with a BMI superior to 50 kg/m2 was ideated by 15 bariatric surgeons from 9 different countries. The questionnaire was emailed to all members of the International Federation of Surgery for Obesity (IFSO). Responses were collected and analyzed by the authors.Results789 bariatric surgeons from 73 countries participated in the survey. Most surgeons (89.9%) believed that metabolic/bariatric surgery (MBS) on patients with BMI over 50 kg/m2 should only be performed by expert bariatric surgeons. Half of the participants (55.3%) believed that weight loss must be encouraged before surgery and 42.6% of surgeons recommended an excess weight loss of at least 10%. However, only 3.6% of surgeons recommended the insertion of an Intragastric Balloon as bridge therapy before surgery. Sleeve Gastrectomy (SG) was considered the best choice for patients younger than 18 or older than 65 years old. SG and One Anastomosis Gastric Bypass were the most common procedures for individuals between 18 and 65 years. Half of the surgeons believed that a 2-stage approach should be offered to patients with BMI > 50 kg/m2, with SG being the first step. Postoperative thromboprophylaxis was recommended for 2 and 4 weeks by 37.8% and 37.7% of participants, respectively.ConclusionThis survey demonstrated worldwide variations in bariatric surgery practice regarding patients with a BMI superior to 50 kg/m2. Careful analysis of these results is useful for identifying several areas for future research and consensus building.

Assessment of the Quality and Reliability of Intragastric Balloon Videos on YouTube.

There is no mechanism to control the accuracy and quality of videos on YouTube. However, it is essential to evaluate the quality of videos on YouTube to prevent patients from accessing misleading information. The aim of this study was to assess the quality and reliability of the videos available on YouTube concerning intragastric balloon. YouTube was searched using the keywords "intragastric balloon" and "gastric balloon." A total of 158 videos were independently analyzed by two bariatric surgeons-endoscopists and were classified as reliable or non-reliable. Video demographics (view, view per day, like, dislike, comment) were analyzed according to the quality and source of the video. The video power index (VPI) was calculated for each video. The modified DISCERN and global quality scores (GQS) were used to rate the reliability and overall quality of the videos. Of the included videos, 63.9% were described reliable and 36.1% as non-reliable. The median number of dislikes, comments, views, views per day, and video duration on YouTube did not significantly differ between the two reliability groups. The mean length of the videos, GQS and DISCERN scores, and the median number of likes were significantly higher in the reliable group. The highest median VPI value was determined for the videos uploaded by TV programs. The number of reliable videos is higher than non-reliable about intragastric balloon on YouTube. However, the reliability and quality of the videos are generally low. The videos uploaded by TV programs are significantly more popular.

Spanish Intragastric Balloon Consensus Statement (SIBC): practical guidelines based on experience of over 20 000 cases.

intragastric balloons (IGBs) are a minimally invasive, increasingly popular option for obesity treatment. However, there is only one worldwide guideline standardizing the technical aspects of the procedure (BIBC, SOARD 2018). to construct a practical guideline for IGB usage by reproducing and expanding the BIBC survey among the Spanish Bariatric Endoscopy Group (GETTEMO). a 140-question survey was submitted to all GETTEMO members. Twenty-one Spanish experienced endoscopists in IGBs answered back. Eight topics on patient selection, indications/contraindications, technique, multidisciplinary follow-up, results, safety, and financial/legal aspects were discussed. Consensus was defined as consensus ≥ 70 %. overall data included 20 680 IGBs including 12 different models. Mean age was 42.0 years-old, 79.9 % were women, and the mean preoperative body mass index (BMI) was 34.05 kg/m². Indication in BMI > 25 kg/m², 10 absolute contraindications, and nutritional and medication measures at follow-up were settled. A mean %TBWL (total body weight loss) of 17.66 % ± 2.5 % was observed. Early removal rate due to intolerance was 3.62 %. Adverse event rate was 0.70 % and 6.37 % for major and minor complications with consensual management. A single case of mortality occurred. IGBs were placed in private health, prior contract, and with full and single payment at the beginning. Seven lawsuits (0.034 %) were received, all ran through civil proceeding, and with favorable final resolution. this consensus based on more than 20 000 cases represents practical recommendations to perform IGB procedures. This experience shows that the device leads to satisfactory weight loss with a low rate of adverse events. Most results are reproducible compared to those obtained by the BIBC.

Abdominal Morphologic Changes in MRI during Gastric Balloon Therapy.

Adiposity and excessive weight are on the rise in western industrialized countries. In cases where conservative measures fail and surgical interventions are not (yet) desired, gastric balloon therapy has proven to be a safe and reversible endoscopic method. Aside from weight progression under gastric balloon therapy and by using MRI, our research paper describes the behavior of different abdominal body fat compartments at the beginning and at the end of the gastric balloon therapy. Additionally, the volume of the left liver lobe as well as the fill volume and performance of the gastric balloon were analyzed over the duration of treatment. For assessing potential impacts of weight reduction on the muscle mass, we determined the area of the m. psoas on a comparable cross-sectional area at the beginning and at the end of the therapy. We were able to verify a significant reduction of the layer of subcutaneous fat, adipose capsule of the kidney, and intra-abdominal fatty tissue during the therapy. The volume of the left liver lobe was shrinking in addition to a muscle loss during the balloon therapy. The volume of the gastric balloon remained stable (not hyperinflation). There were variable gas bubbles in the gastric balloon. The gastric balloon is a temporary and successful option for weight reduction by reducing body fat, liver volume, but also muscle mass.

EFFICACY OF INTRAGASTIC BALLOONS IN WEIGHT REDUCTION

The endoscopic application of intragastric balloons (IGB) is a very effective non-surgical technique in the treatment of excess body weight.&nbsp;The aim of this study was to аnalyze the effectiveness of IGB in obesity treatment and tо compare the results of using different types of IGB. The study included 80 overweight patients with a BMI between 25 and 40 kg/m2, treated with the application of two types of IGB (Spatz and Endd-Ball). Weight control of patients was performed 48 hours, 7 days, 14 days, 30 days, 90 days, and 180 days after the IGB placement, as well as 6 months after the IGB removal. Six months after application, the IGBs were endoscopically removed. The number of kilograms lost, as well as the change in BMI, were analyzed. A comparison between the results obtained with the two different types of IGB (Spatz and Edd-Ball) was made. For statistical processing of the data, a database was created in the statistical program SPSS for Windows, .The average weight loss 6 months after the application of IGB was about 15 kg. Comparing BMI values ​​before and 6 months after the intervention showed a statistically significant decrease in BMI after the intervention (p= 0.00) and confirmed the efficacy of IGB. Comparing the lost kilograms in relation to the type of IGB applied did not show statistically significant differences.&nbsp;The application of IGB has shown to be an effective method for weight loss. Keywords: obesity, intragastric balloon, therapy, endoscopy.

Delayed gastric emptying in a patient with an intragastric balloon In situ

Delayed gastric emptying in a patient with an intragastric balloon In situ

Efficacy of intragastric balloon in obese patients

Efficacy of intragastric balloon in obese patients

The role of endoluminal interventions in the preparation of high-risk patients with super-obesity for bariatric surgery

Obesity causes increased morbidity, disability and mortality rates as well as affects the quality of life. Given the known risks to the patient’s health, the International Federation for the Surgery of Obesity and Metabolic Disorders pays special attention to the problem of morbid obesity (body mass index ≥ 40 kg/m2), with particular emphasis on super‑obesity (body mass index ≥ 50 kg/m2). Objective is to investigate the role of endoluminal interventions in the preparation of super obese patients with high risk of surgical and anaesthesia‑related complications for bariatric surgery. Materials and methods. From 2011 to 2018, 97 patients with morbid obesity and high risk of surgery and anaesthesia‑related complications (ASA PS III — IV) underwent a course of treatment at the clinical setting of the Department of General Surgery No2 of Bohomolets National Medical University. The treatment was carried out in 2 stages. In the main group (n = 60), the first stage of treatment included the intragastric balloon placement for a term of 6 months. The control group (n = 37) received a six‑month conservative therapy. In the second stage of treatment the patients of both groups underwent a surgical procedure for the morbid obesity management. Results. The outcomes of the first stage of treatment showed that the patients, who underwent the intragastric balloon placement, had statistically significantly (p &lt; 0.001) higher mean the percentage of excess weight loss (% EWL) than the patients who received conservative therapy. In the main group, the average ASA PS score, which is identified as an anaesthetic and surgical risk indicator, decreased from 3.28 (95 % confidence interval (CI) 3.17 — 3.40) to 2.15 (95 % CI 2.06 — 2.24, p &lt; 0.001), and in the control group — from 3.24 (95 % CI 3.10 — 3.39) to 3.14 (95 % CI 2.96 — 3.31, p &gt; 0.05). Conclusions. The results of the study provide strong evidence that the intragastric balloon placement for a term of 6 months reduces surgical and anaesthetic risks, contributes to the improved function of the cardiovascular and respiratory systems as well as gives a boost to carbohydrate metabolism, and, therefore, can be suggested for the preparation of super obese patients with high risk of surgical and anaesthesia‑related complications for bariatric surgery.