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Thaher O, Mansour R, Hukauf M, Croner RS, Stroh C. Is Gastric Balloon Implantation Still an Effective Procedure for the Management of Obesity and Associated Conditions? Findings from a Multi-Center Study. Obes Surg 2024; 34:4350-4357. [PMID: 39527230 DOI: 10.1007/s11695-024-07552-3] [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: 05/18/2024] [Revised: 10/12/2024] [Accepted: 10/16/2024] [Indexed: 11/16/2024]
Abstract
PURPOSE Both surgical and endoscopic procedures represent a mainstay of obesity treatment. Several procedures have been developed in recent years, although their impact on obesity is variable. This study examines and presents the results of a 6-month gastric balloon implantation (GBI). MATERIAL AND METHODS The data from the German Bariatric Surgery Registry (GBSR) for the period from 2005 to 2021 were subjected to a multi-center analysis. Six months following GBI, demographic data, the peri-interventional course, weight, BMI reduction, as well as the development of comorbidities (arterial hypertension (aHTN), diabetes mellitus (T2D), reflux (GERD), and sleep apnea syndrome (OSAS)), were evaluated in male and female patients. RESULTS Of 3754 patients, 788 (45.3% male, 54.7% female) met the inclusion criteria for the study. Following 6 months of therapy, an average weight loss of 19.3 ± 15.2 kg was observed in male patients, while female patients exhibited an average weight loss of 16.3 ± 13.1 kg (p = 0.013). The EWL was found to be significantly higher in female patients than in male patients (24.8 vs. 18; p < 0.001). BMI reduction, %TWL, and mortality rate showed no significant disadvantage in either group (p > 5%). After 6 months of therapy, there was a significant advantage for women in the remission of aHTN. The remaining comorbidities did not differ significantly between the two groups (p > 5%). CONCLUSIONS GBI is an efficacious procedure for the treatment of obese patients with mild obesity and comorbidities or as a bridging procedure prior to planned bariatric surgery.
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Affiliation(s)
- Omar Thaher
- Department of Surgery, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany.
| | - Rafee Mansour
- German Centre for Orthopaedics, Waldkliniken Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Martin Hukauf
- StatConsult Society for Clinical and Health Services Research GmbH, Am Fuchsberg 11, 39112, Magdeburg, Germany
| | - Roland S Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Christine Stroh
- Department of General, Abdominal and Pediatric Surgery, Municipal Hospital, Straße des Friedens 122, 07548, Gera, Germany
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Pilone V, Vitiello A. Biography of Professor Pietro Forestieri, Honorary President of the Italian Society for the Surgery of Obesity (SICOB). Obes Surg 2024; 34:2005-2006. [PMID: 38643295 DOI: 10.1007/s11695-024-07231-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/22/2024]
Affiliation(s)
- Vincenzo Pilone
- Public Health Department, Naples "Federico II" University, AOU "Federico II" - via S.Pansini 5, Naples, Italy
| | - Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II" - via S. Pansini 5, 80131, Naples, Italy.
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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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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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Kozłowska-Petriczko K, Pawlak KM, Wojciechowska K, Reiter A, Błaszczyk Ł, Szełemej J, Petriczko J, Wiechowska-Kozłowska A. The Efficacy Comparison of Endoscopic Bariatric Therapies: 6-Month Versus 12-Month Intragastric Balloon Versus Endoscopic Sleeve Gastroplasty. Obes Surg 2023; 33:498-505. [PMID: 36525237 PMCID: PMC9889469 DOI: 10.1007/s11695-022-06398-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Intragastric balloon (IGB) insertion and endoscopic sleeve gastroplasty (ESG) are known to be effective and safe in achieving weight loss. The aim of this study was to compare the effects of a 6-month IGB therapy, a 12-month IGB therapy, and ESG. METHODS We retrospectively analyzed the weight loss at IGB (Orbera) removal after 6 months (124 patients), at IGB (Orbera365) removal after 12 months (61 patients) and at 6 and 12 months after ESG (42 and 34 patients, respectively). Postprocedural care, including medication and diet, was the same for all procedures. RESULTS Mean TBWL in patients undergoing IGB placement for 6 and 12 months and ESG after 6 and 12 months were 15.2, 15.8, 26.5, and 28.7 kg, respectively. There was no significant difference in the mean %TBWL in patients undergoing IGB placement for 6 or for 12 months (15.3% vs. 14.7%, P = 0.7). ESG patients showed a significantly higher mean %TBWL than IGB patients after 6 months (15.3 vs. 19.8, P = 0.005) and 12 months (14.7 vs. 22.5, P < 0.001). CONCLUSION All three studied methods were effective for achieving weight loss. However, there was no significant difference between 6-month and 12-month IGB therapies outcomes. ESG appeared to be a more effective obesity treatment modality than IGB.
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Affiliation(s)
| | - K M Pawlak
- Endoscopy Unit, Department of Gastroenterology, Hospital of the Ministry of Interior and Administration, Szczecin, Poland
| | - K Wojciechowska
- Department of Internal Medicine and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - A Reiter
- Endoscopy Unit, Regional Health Center, Lubin, Poland
| | - Ł Błaszczyk
- Endoscopy Unit, Sonomed Medical Centre, Szczecin, Poland
| | - J Szełemej
- Endoscopy Unit, Regional Health Center, Lubin, Poland
| | - J Petriczko
- Department of Plastic, Endocrine and General Surgery, Pomeranian Medical University, Szczecin, Poland
| | - A Wiechowska-Kozłowska
- Endoscopy Unit, Department of Gastroenterology, Hospital of the Ministry of Interior and Administration, Szczecin, Poland
- Endoscopy Unit, Sonomed Medical Centre, Szczecin, Poland
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Shah R, Davitkov P, Abu Dayyeh BK, Saumoy M, Murad MH. AGA Technical Review on Intragastric Balloons in the Management of Obesity. Gastroenterology 2021; 160:1811-1830. [PMID: 33832658 DOI: 10.1053/j.gastro.2021.02.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Several strategies are available to address the obesity epidemic and range from noninvasive lifestyle interventions to medications and bariatric surgical procedures. Endoscopic bariatric techniques, such as intragastric balloons, have become an attractive alternative as a tool for weight loss that can augment the effect of lifestyle interventions. This technical review includes multiple systematic reviews performed to support a clinical practice guideline by the American Gastroenterological Association on the role of intragastric balloons as a tool for weight loss. The systematic reviews targeted a priori selected clinical questions about the effectiveness and periprocedural care of intragastric balloons and concomitant and subsequent weight-loss strategies.
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Affiliation(s)
- Raj Shah
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Veterans Affairs, Northeast Ohio Healthcare System, Cleveland, Ohio; University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Perica Davitkov
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Veterans Affairs, Northeast Ohio Healthcare System, Cleveland, Ohio
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Monica Saumoy
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - M Hassan Murad
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
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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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8
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IFSO Endoscopy Committee Position Statement on the Practice of Bariatric Endoscopy During the COVID-19 Pandemic. Obes Surg 2020; 30:4179-4186. [PMID: 32623686 PMCID: PMC7334630 DOI: 10.1007/s11695-020-04826-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
COVID-19 (Coronavirus disease 2019) caused by SARS-CoV-2 has become a global pandemic. Obesity is a risk factor for severe disease, and the practice of endoscopy poses special challenges and risks of SARS-CoV-2 transmission to patients and providers given the evolving role of the gastrointestinal tract in viral transmission and aerosol generation during endoscopic procedures. It is therefore necessary to distinguish between urgent interventions that cannot be postponed despite the risks during the pandemic and, in contrast, purely elective interventions that could be deferred in order to minimize transmission risks during a time of infection surge and limited access. Semi-urgent bariatric procedures have an intermediate position. Since the chronological course of the pandemic is still unpredictable, these interventions were defined according to whether or not they should be performed within a nominal 8-week period. In this position statement, the IFSO Endoscopy Committee offers guidance on navigating bariatric endoscopic procedures in patients with obesity during the COVID-19 pandemic, in the hope of mitigating the risk of SARS-CoV-2 transmission to vulnerable patients and healthcare workers. These recommendations may evolve as the pandemic progresses.
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Beaudreuil S, Iglicki F, Ledoux S, Elias M, Obada ENN, Hebibi H, Durand E, Charpentier B, Coffin B, Durrbach A. Efficacy and Safety of Intra-gastric Balloon Placement in Dialyzed Patients Awaiting Kidney Transplantation. Obes Surg 2019; 29:713-720. [PMID: 30474792 DOI: 10.1007/s11695-018-3574-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The number of obese patients who are candidates for renal transplantation has considerably increased, but obesity can be a barrier to kidney transplantation. Weight loss is often difficult through diet alone. We studied the efficacy and tolerance of the intra-gastric balloon (IGB) procedure in obese patients who were undergoing dialysis and were candidates for a renal transplantation. PATIENTS AND METHODS Obese patients (BMI > 30 kg/m2) who were candidates for renal transplantation were prospectively included in the study between 2010 and 2012. The balloon was inserted and removed during a gastric endoscopy under general anesthesia. The treatment lasted 6 months. The end point was a decrease in BMI after 6 months. Body impedance spectrometry (BIS) and nutritional statute were evaluated initially and then after IGB removal. RESULTS Seventeen patients (nine females and eight males) with a mean age of 53.4 years [19.4-69.4] were included. The decrease in body mass index (BMI) during the 6-month placement was 3 kg/m2 (from 37.7 to 34.4 kg/m2). The mean weight loss was 7 kg. The mean percentage of excess weight loss after 6 months was 20.2 (± 11.4). The tolerance was good without any complications. Eleven patients underwent kidney transplantation. CONCLUSION IGB in obese dialyzed patients who are candidates for renal transplantation is safe and effective. However, the amount of weight loss can vary.
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Affiliation(s)
- Séverine Beaudreuil
- Department of Nephrology Dialysis, Transplantation, IFRNT, University of Paris-Sud, Le Kremlin Bicetre, France. .,INSERM UMRS1197, Villejuif, France.
| | - Franck Iglicki
- Gastroenterology Unit, AP-HP, Louis Mourier Hospital and Denis Diderot University Paris 7, Paris, France
| | - Séverine Ledoux
- Service des Explorations Fonctionnelles and Centre Intégré Nord Francilien de prise en charge de l'Obésité (CINFO), Hôpital Louis Mourier (AP-HP) and Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Michelle Elias
- Department of Nephrology Dialysis, Transplantation, IFRNT, University of Paris-Sud, Le Kremlin Bicetre, France
| | - Erika NNang Obada
- Department of Nephrology Dialysis, Transplantation, IFRNT, University of Paris-Sud, Le Kremlin Bicetre, France
| | - Hadia Hebibi
- Department of Nephrology Dialysis, Transplantation, IFRNT, University of Paris-Sud, Le Kremlin Bicetre, France
| | - Emmanuel Durand
- IR4M (UMR8081), 91405 Univ Paris Sud, Univ Paris Saclay, Department of Nuclear Medicine, Hôpitaux Universitaires Paris Sud, Paris, France
| | - Bernard Charpentier
- Department of Nephrology Dialysis, Transplantation, IFRNT, University of Paris-Sud, Le Kremlin Bicetre, France.,INSERM UMRS1197, Villejuif, France
| | - Benoit Coffin
- Gastroenterology Unit, AP-HP, Louis Mourier Hospital and Denis Diderot University Paris 7, Paris, France
| | - Antoine Durrbach
- Department of Nephrology Dialysis, Transplantation, IFRNT, University of Paris-Sud, Le Kremlin Bicetre, France.,INSERM UMRS1197, Villejuif, France
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Abstract
Intragastric balloons (IGBs) are the most widely available endoscopic bariatric therapy for class I and II obesity in the United States. Although simple in application and reversible by nature, these devices may help patients initiate the important first steps in weight loss maintenance, provided that parallel efforts are in motion to prevent weight recidivism. Too often, therapeutic nihilism stems from unrealistic expectations of a given therapy. In the case of IGBs, this sentiment may occur when these interventions are applied in a vacuum and not within the purview of a multidisciplinary program that actively involves dieticians, endocrinologists, gastroenterologists, and surgeons. There is a clear and present need to apply different tactics in the remissive strategy to control the obesity pandemic, more so in a struggling landscape of an ever-widening gap in bridging interventions. With such demand, the IGB is an available tool that could be helpful when correctly implemented. In this exposition, we summarize the current state of IGBs available worldwide, discuss their mechanism of action, relay evidence for their short- and long-term efficacy, address safety profile concerns, and suggest procedural considerations in the real-world quotidian application.
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12
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Glass J, Chaudhry A, Zeeshan MS, Ramzan Z. New Era: Endoscopic treatment options in obesity–a paradigm shift. World J Gastroenterol 2019; 25:4567-4579. [PMID: 31528087 PMCID: PMC6718037 DOI: 10.3748/wjg.v25.i32.4567] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/30/2019] [Accepted: 08/07/2019] [Indexed: 02/06/2023] Open
Abstract
The prevalence of obesity continues to rise, and along with it comes a multitude of health-related consequences. The healthcare community has consistently struggled with providing treatment options to obese patients, in part due to the reluctance of patients in pursuing the more effective (yet invasive) surgical approaches such as sleeve gastrectomy and Rou-en-Y gastric bypass. On the other hand, the less invasive approach such as lifestyle/behavioral interventions and pharmacotherapy (Orlistat, Phenteramine, Phentermine/Topiramate, Locaserin, Naltrexon/Buproprion, and Liraglutide) have very limited efficacy, especially in the morbidly obese patients. Despite our best efforts, the epidemic of obesity continues to rise and pose enormous costs on our healthcare system and society. Bariatric endoscopy is an evolving field generated to combat this epidemic through minimally invasive techniques. These procedures can be performed in an ambulatory setting, are potentially reversible, repeatable, and pose less complications than their invasive surgical counterparts. These modalities are designed to alter gut metabolism by means of space occupation, malabsorption, or restriction. In this review we will discuss different bariatric endoscopic options (such as intragastric balloons, endoscopic sleeve gastroplasty, endoscopic aspiration therapies and gastrointestinal bypass sleeves), their advantages and disadvantages, and suggest a new paradigm where providers may start incorporating this modality in their treatment approach for obese patients.
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Affiliation(s)
- Jason Glass
- Department of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
| | - Ahson Chaudhry
- Division of Gastroenterology and Hepatology, Department of Medicine, Dallas VA Medical Center, VA North Texas Health Care System, Dallas, TX 75216, United States
- School of Medicine, Temple University Hospital, Philadelphia, PA 19140, United States
| | - Muhammad S Zeeshan
- Division of Gastroenterology and Hepatology, Department of Medicine, Dallas VA Medical Center, VA North Texas Health Care System, Dallas, TX 75216, United States
| | - Zeeshan Ramzan
- Division of Gastroenterology and Hepatology, Department of Medicine, Dallas VA Medical Center, VA North Texas Health Care System, Dallas, TX 75216, United States
- Department of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
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Bhandari M, Fobi MAL, Buchwald JN. Standardization of Bariatric Metabolic Procedures: World Consensus Meeting Statement. Obes Surg 2019; 29:309-345. [PMID: 31297742 DOI: 10.1007/s11695-019-04032-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Standardization of the key measurements of a procedure's finished anatomic configuration strengthens surgical practice, research, and patient outcomes. A consensus meeting was organized to define standard versions of 25 bariatric metabolic procedures. METHODS A panel of experts in bariatric metabolic surgery from multiple continents was invited to present technique descriptions and outcomes for 4 classic, or conventional, and 21 variant and emerging procedures. Expert panel and audience discussion was followed by electronic voting on proposed standard dimensions and volumes for each procedure's key anatomic alterations. Consensus was defined as ≥ 70% agreement. RESULTS The Bariatric Metabolic Surgery Standardization World Consensus Meeting (BMSS-WOCOM) was convened March 22-24, 2018, in New Delhi, India. Discussion confirmed heterogeneity in procedure measurements in the literature. A set of anatomic measurements to serve as the standard version of each procedure was proposed. After two voting rounds, 22/25 (88.0%) configurations posed for consideration as procedure standards achieved voting consensus by the expert panel, 1 did not attain consensus, and 2 were not voted on. All configurations were voted on by ≥ 50% of 50 expert panelists. The Consensus Statement was developed from scientific evidence collated from presenters' slides and a separate literature review, meeting video, and transcripts. Review and input was provided by consensus panel members. CONCLUSIONS Standard versions of the finished anatomic configurations of 22 surgical procedures were established by expert consensus. The BMSS process was undertaken as a first step in developing evidence-based standard bariatric metabolic surgical procedures with the aim of improving consistency in surgery, data collection, comparison of procedures, and outcome reporting.
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Affiliation(s)
- Mohit Bhandari
- Department of Surgery, Sri Aurobindo Medical College and Postgraduate Institution, Mohak Bariatric and Robotic Surgery Centre, Indore, MP, India.
| | - M A L Fobi
- Department of Surgery, Sri Aurobindo Medical College and Postgraduate Institution, Mohak Bariatric and Robotic Surgery Centre, Indore, MP, India
| | - Jane N Buchwald
- Division of Scientific Research Writing, Medwrite Medical Communications, Maiden Rock, WI, USA
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Bayraktar O, Özçelik AA, Öktemgil AR, Bayraktar B. Intragastric balloon therapy for obesity: Is it safe and effective? ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2019. [DOI: 10.25000/acem.477680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Laparoscopic removal of gastric balloon after failure of endoscopic retrieval. Int J Surg Case Rep 2019; 55:210-212. [PMID: 30771624 PMCID: PMC6376151 DOI: 10.1016/j.ijscr.2019.01.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/23/2019] [Accepted: 01/29/2019] [Indexed: 01/10/2023] Open
Abstract
Delayed extraction of gastric balloons increase rate of complications. Failure of endoscopic retrieval is a rare complication. Laparoscopic retrieval of gastric balloon is an option in the management. Introduction Different therapeutic measures have been developed in the treatment of obesity. Gastric balloon is a minimally-invasive modality in obesity treatment, but it is not without a risk of complications. Presentation of case We present a 44-year-old morbidly obese lady who underwent gastric balloon insertion and refused to remove it at the recommended time. Unfortunately, after 18 months from insertion of the balloon, she was brought to the Emergency Department with symptoms of gastric outlet obstructions. Endoscopic retrieval of the balloon has failed. Hence, surgical intervention was planned and the balloon was successfully removed laparoscopically. Discussion Gastric balloons are designed to remain in the stomach for 6 months. Delayed extraction of the balloon associated with increase in the rate of complications. In our case, it was difficult to retrieve the balloon endoscopically due to thickened balloon wall, which was then removed laparoscopically safely without any complications. Conclusion Laparoscopic extraction of the gastric balloon is a safe and feasible option in the management of difficult endoscopic retrieval.
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An Autopsy Case of Misdiagnosed Wernicke's Syndrome after Intragastric Balloon Therapy. Case Rep Gastrointest Med 2018; 2018:1510850. [PMID: 29666718 PMCID: PMC5831924 DOI: 10.1155/2018/1510850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/06/2018] [Accepted: 01/21/2018] [Indexed: 01/21/2023] Open
Abstract
Intragastric balloon (IGB) therapy is a widely used technique to counter obesity, and it is known to be safe and effective. Although there can be a high rate of side effects following IGB therapy, most are self-healing and they are mainly accommodative in nature. Few cases of Wernicke's syndrome under IGB therapy have been described in the literature, and to the best of our knowledge, none have been fatal. We present here a case of a 51-year-old woman who underwent IGB therapy over 8 months. Late diagnosed Wernicke's syndrome that first appeared as lower limb neuropathy progressively immobilized the patient, until she required bed rest. Finally, a major complication of pneumonia caused her death. Wernicke's syndrome has been mainly related to bariatric surgery techniques, but it must also be linked to IGB therapy (and also to other restrictive weight-loss interventions). As the use of IGB therapy spreads, the literature must alert physicians to this complication. Wernicke's syndrome is a severe but reversible condition when diagnosed and treated early.
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Mariani S, Fiore D, Persichetti A, Basciani S, Lubrano C, Poggiogalle E, Genco A, Donini LM, Gnessi L. Circulating SIRT1 Increases After Intragastric Balloon Fat Loss in Obese Patients. Obes Surg 2017; 26:1215-20. [PMID: 26337692 DOI: 10.1007/s11695-015-1859-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Sirtuins (SIRTs), ubiquitous deacetylases, are main regulators of energy homeostasis and metabolism. SIRT1 has a positive impact on obesity, diabetes mellitus, liver steatosis, and other metabolic disorders. Lean subjects have higher expression of SIRT1 in the adipose tissue compared to obese. However, it is not known whether weight loss associates with changes in blood SIRT1. We evaluated the effect of weight loss on circulating SIRT1, metabolic parameters, and body composition. METHODS Thirty-two obese subjects were studied before and 6 months after BioEnterics® Intragastric Balloon (BIB®) [22 patients, BMI 41.82 ± 6.28 kg/m(2)] or hypocaloric diet [10 patients, BMI 38.95 ± 6.90 kg/m(2)]. Plasma SIRT1, body composition, measures of metabolic syndrome (waist circumference, fasting plasma glucose, blood pressure, HDL cholesterol, triglycerides), and inflammation markers (ESR, CRP, fibrinogen) were recorded. RESULTS SIRT1 levels showed a significant increase, together with a significant reduction of BMI, excess body weight, and total fat mass either after BIB or diet intervention. The percent excess body weight loss was 33.73 ± 19.06 and 22.08 ± 11.62 % after BIB and diet, respectively, a trend toward a metabolic and inflammatory amelioration was observed with both treatments. Negative correlation between SIRT1 and % fat mass (BIB, ρ = -0.537, p = 0.017; diet, ρ = -0.638, p = 0.047) was also seen. CONCLUSIONS The reduction of fat mass associates with increased plasma SIRT1 indicating that, besides tissue levels, circulating SIRT1 is stimulated by a negative caloric balance. The rise of plasma SIRT1 may represent a parameter associating with fat loss rather than weight lowering regardless of the weight reduction system method used.
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Affiliation(s)
- Stefania Mariani
- Department of Experimental Medicine, Section of Medical Physiopathology and Endocrinology, Sapienza University of Rome, 00161, Rome, Italy.
| | - Daniela Fiore
- Department of Experimental Medicine, Section of Medical Physiopathology and Endocrinology, Sapienza University of Rome, 00161, Rome, Italy
| | - Agnese Persichetti
- Department of Experimental Medicine, Section of Medical Physiopathology and Endocrinology, Sapienza University of Rome, 00161, Rome, Italy
| | - Sabrina Basciani
- Department of Experimental Medicine, Section of Medical Physiopathology and Endocrinology, Sapienza University of Rome, 00161, Rome, Italy
| | - Carla Lubrano
- Department of Experimental Medicine, Section of Medical Physiopathology and Endocrinology, Sapienza University of Rome, 00161, Rome, Italy
| | - Eleonora Poggiogalle
- Department of Experimental Medicine, Section of Medical Physiopathology and Endocrinology, Sapienza University of Rome, 00161, Rome, Italy
| | - Alfredo Genco
- Department of Surgical Sciences, Surgical Endoscopy Unit, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Maria Donini
- Department of Experimental Medicine, Section of Medical Physiopathology and Endocrinology, Sapienza University of Rome, 00161, Rome, Italy
| | - Lucio Gnessi
- Department of Experimental Medicine, Section of Medical Physiopathology and Endocrinology, Sapienza University of Rome, 00161, Rome, Italy
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Gastric Occlusion Due to Intragastric Balloon with Gastric Necrosis and Portal Pneumatosis. ACG Case Rep J 2017; 3:e184. [PMID: 28119935 PMCID: PMC5226199 DOI: 10.14309/crj.2016.157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 07/27/2016] [Indexed: 11/17/2022] Open
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Endoscopic treatment of obesity. Curr Opin Gastroenterol 2016; 32:487-491. [PMID: 27607342 DOI: 10.1097/mog.0000000000000307] [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: 12/10/2022]
Abstract
PURPOSE OF REVIEW Obesity and its comorbid illnesses affect millions worldwide and are one of the major causes of preventable death in the world. Bariatric surgery is currently offered to individuals with a BMI greater than 40 kg/m or greater than 35 kg/m with obesity-related comorbidities such as hypertension or diabetes. Endoscopic bariatric therapies, with their reduced invasiveness and potential reversibility, may complement surgical approaches for achieving weight loss. RECENT FINDINGS At the time of this writing, two endoscopically placed intragastric balloons and an endoscopically placed aspiration tube have been approved by the Food and Drug Administration for weight loss purposes. Some devices employ a suturing platform to create plications or to appose two surfaces. Other endoscopic strategies under investigation to treat obesity-related comorbidities such as diabetes include duodenal mucosal resurfacing and creation of a partial jejunoileal diversion using self-assembling magnets. SUMMARY Current endoscopic methods for the treatment of obesity utilize various mechanisms, including occupying gastric volume, reducing gastric capacity, altering caloric absorption, or aspirating gastric contents. The long-term outcomes and cost-effectiveness of these strategies remain to be fully elucidated. The landscape of endoscopic bariatric therapies continues to evolve.
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Neylan CJ, Dempsey DT, Tewksbury CM, Williams NN, Dumon KR. Endoscopic treatments of obesity: a comprehensive review. Surg Obes Relat Dis 2016; 12:1108-1115. [DOI: 10.1016/j.soard.2016.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 01/30/2016] [Accepted: 02/07/2016] [Indexed: 12/23/2022]
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Ali MR, Moustarah F, Kim JJ. American Society for Metabolic and Bariatric Surgery position statement on intragastric balloon therapy endorsed by the Society of American Gastrointestinal and Endoscopic Surgeons. Surg Obes Relat Dis 2016; 12:462-467. [DOI: 10.1016/j.soard.2015.12.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 12/18/2015] [Indexed: 12/16/2022]
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