RESUMO
Obesity raises such a healthcare matter throughout the world. Its management is not only complex but also most often multidisciplinary. The medico-dietary treatment is of inconstant efficiency and the surgical treatment, though more efficient, presents a considerable morbidity-death rate. The endoscopic treatment through intra-gastric balloon avails a seducing alternative namely accounting for surgery preparation. To assess the efficiency of the endoscopic treatment through gastric balloon, both in the short and long term, and this is accounting for weight loss as well as tolerance. We have carried out a retrospective study including the patients suffering from severe to morbid obesity and who had a gastric balloon implemented in our Endoscopy Unit between November 2005 and December 2007. Twenty one patients were included. The average age was 32,19 +/- 12,65 years with extremes of 16 and 52 years. Fifteen patients suffered from morbid obesity. The patients' average weight was 134, 52 +/- 26,46 kg [extremes 88 and 194 kg]. Some co-morbidity was found out with 15 patients. Te balloon implementation [Héliosphère[registered sign]] was carried out with no incidents in all patients. Six months after the balloon implementation, the average weight loss was17,5% and the average loss of overweigh was 37%. In biological level, we noted a normalisation of fasting glycaemia in 28,6 % of cases, of the cholesterolemia in 100 %, of the triglyceridemia in 33,33%, of the uraemia in 42,8% and hepatic tests in 50 % of the cases. The metabolic syndrome disappeared in 28,57 % of cases. The assessment after a 5-year-period was marked by the need to surgical treatment in 4 patients and this is due to the loss of efficiency of endoscopic treatment. A bad tolerance of gastric balloon was observed in 34 % of the cases, dominated by sicknesses. Only one patient presented incoercible sicknesses with ionic troubles as well as deshydrating requiring the precocious extraction of the balloon after 48 hours of its implementation. The endoscopic treatment through intra gastric balloon is well tolerated but efficiently limited in time. It might be recommended in preparation for a surgical treatment or in case of contre- indication or surgery refusal
RESUMO
Malnutrition is a frequently reported complication in patients with liver cirrhosis. It has a high clinical and economic impact reflected by an increased morbidity and prolonged hospital stay. This preliminary prospective study aimed to determine the prevalence of malnutrition in hospitalized cirrhotic patients and to investigate whether biological and anthropometric parameters are a valuable tool for identifying malnutrition in these patients. The nutritional status of 44 consecutive cirrhotic patients [21 men, 23 women] was assessed according to the anthropometric measurements and biochemical analysis. The diagnosis of malnutrition was based on diminished values of Mid arm muscle circumference [MAMC] and/or Triceps skinfold thikness [TST] below the 5th percentile or less than 60%. The aetiology of cirrhosis was viral hepatitis in 29 patients [66%]. Cirrhosis was classified Child Pugh A, B or C in respectively 9, 26 and 9 patients; 37 patients [84%] have mild or tense ascite. In this study, malnutrition was found in 35 patients [79.5%], whereas 9 patients has a good nutritional status. TST and MAMC less than 60%was found in respectively 72%and 25%of patients. No significant statistical difference in epidemiological characteristics was found between malnourished and well-nourished patients. TST and MAMC decreased significantly according to the Child score [p=0.014 and 0.032 respectively; a positive correlation was found between these two paramelers and the severity of cirrhosis. In this study, the high prevalence of denutrition was associated with the severity of cirrhosis. Anthropometric parameters are valuable tools for malnutrition diagnosis