Pancreatitis aguda asociada a balón intragástrico: reporte de caso y revisión de la literatura

La obesidad es una patología de importancia a nivel mundial porque conlleva a una alta carga de mortalidad y morbilidad. El balón intragástrico representa una técnica no quirúrgica empleada cada vez con más frecuencia para lograr pérdida de peso. Si bien, este se considera un método seguro, se han reportado algunas complicaciones desde náuseas y vómitos, hasta eventos adversos graves, tales como perforación. La pancreatitis aguda constituye una complicación muy rara del balón intragástrico y se atribuye su efecto a la compresión directa que ejerce sobre el páncreas. Presentamos el caso de una paciente mujer de 21 años, quien después de 7 meses de colocación de balón intragástrico, cursó con dolor abdominal, náuseas y vómitos, asociados a elevación de enzimas pancreáticas. Se hizo diagnóstico de pancreatitis aguda y se corroboró compresión de la cola del páncreas mediante estudio tomográfico. Se decidió retiro del balón mediante endoscopía, cursando luego con evolución favorable.

Obesity is a pathology of importance worldwide because it leads to a high burden of mortality and morbidity. The intragastric balloon represents a non-surgical technique used more and more frequently to achieve weight loss. Although this is considered a safe method, some complications have been reported, from nausea and vomiting to serious adverse events, such as perforation. Acute pancreatitis is a very rare complication of the intragastric balloon, and its effect is attributed to the direct compression it exerts on the pancreas. We present the case of a 21-year-old female patient who, after 7 months of intragastric balloon placement, developed abdominal pain, nausea, and vomiting, associated with elevated pancreatic enzymes. A diagnosis of acute pancreatitis was made and compression of the tail of the pancreas was confirmed by tomographic study. It was decided to remove the balloon by endoscopy, which then progressed favorably.

Intragastric balloon for weight reduction: rationale, benefits, risks and indications / 南方医科大学学报

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.

Efficacy and safety of intragastric balloon in the treatment of obesity in adolescent females

BACKGROUND: The aims of this study are to evaluate the efficacy and safety of intragastric balloon (IB) to reduce the weight and body mass index (BMI) in severely obese adolescent females and to describe the changes in the liver enzymes and lipid and glucose metabolism biomarkers. METHODS: This study included 10 severely obese post-menarche adolescent females. We evaluated anthropometric data, lipid profile, glucose metabolism biomarkers, and liver enzymes before insertion and after removal of the IB. RESULTS: BMI and weight reduction were larger during the first month of intervention. Especially in the first week, there was a reduction of 1.74 ± 0.46 kg/m2(p= 0.004) and 6.46 ± 1.52 kg (p= 0,002), respectively. After 3 months, there wasan average BMI reduction of 4.29 ± 1.04 kg/m (p= 0.005) and weight reduction of 12.9 ± 3.08 kg (p= 0.004). From the initial moment to study conclusion, there was a statistically significant reduction in insulin levels (9.0 ± 2.8 U/mL; p=0.012) and in homeostatic model assessment-insulin resistance (2.0 ± 0.6;p= 0.009). Five patients reported, during the first week, epigastric pain; nausea and vomiting were observed in two patients. No adolescents presented dysphagia during IB use. CONCLUSION: IB use in adolescent females with severe obesity in association with a conservative multidisciplinary treatment had a positive impact in BMI reduction, with few adverse effects. There was also an improvement in insulin resistance.

Gastric Perforation Caused by an Intragastric Balloon: Endoscopic Findings

Intragastric balloon (IGB) insertion has been most frequently used in the West as an effective endoscopic treatment for morbid obesity, in practice. Recently, there is a growing number of cases requiring IGB deployment for obesity treatment in Korea. One of the reported complications of IGB use is gastric perforation. A 47-year-old woman was admitted to the hospital with mild symptoms, 7 weeks after having an IGB placed. Esophagogastroduodenoscopy was performed and gastric ulcer perforation was observed in the ulcer base, where food particles were impacted. Laparoscopic primary repair was done successfully. This was a case of gastric perforation, secondary to poor compliance with a proton-pump inhibitor (PPI). PPI and Helicobacter pylori eradication are important for ulcer prevention following IGB deployment.

Apoyo social y adhesión terapéutica en balón intragástrico bioenteric / SOCIAL SUPPORT AND ADHERENCE TO THERAPY IN BIOENTERICS INTRAGASTRIC BALLOON

Introducción: el poco éxito obtenido con la aplicación de los tratamientos médicos en los sujetos con obesidad mórbida, es un factor que predispone al clínico a buscar otras medidas terapéuticas, surgiendo así el balón intragástrico BioEnteric (BIB). No obstante, para que esta técnica sea efectiva, el individuo debe realizar un esfuerzo constante y progresivo para controlar su ingesta alimenticia. Este esfuerzo requiere una participación activa tanto de la persona como de su contexto social en la modificación de su conducta.Objetivo: determinar la relación entre el apoyo social percibido y la adhesión terapéutica en pacientes que se les ha colocado el BIB. Material y método: participaron 75 obesos (56 mujeres y 19 hombres), entre los 18 y 65 años (M= 39.29; DT= 11.82), que asistieron a cinco centros de la ciudad de Caracas, donde se lleva a cabo este procedimiento. Se utilizaron la Escala de Apoyo Social y un cuestionario ad hoc de comportamientos de adhesión terapéutica dirigido a personas que se les ha colocado el BIB. Inicialmente se contactó a los centros clínicos y se seleccionó la muestra. Posteriormente, se aplicaron los inventarios antes y en cada mes posterior a la introducción del balón por un espacio de tres meses. Resultados: los participantes se caracterizaron por presentar niveles moderados en las distintas variables. Por otro lado, quienes percibieron apoyo de amigos y/o cercanos, son aquellos que reportan adhesión terapéutica. Conclusiones: se sugiere promover las redes de apoyo social dado que podrían ser indispensables para lograr y mantener la adhesión.

Introduction: The lack of success obtained applying medical treatments in obese people is a critical element that triggers the process of finding other therapeutic procedures, arising then the BioEnteric Intragastric Baloon (BIB). However, this procedure requires an constant effort by the individual measuring and controlling the food intake in order to obtain effective and positive results. This aforementioned effort also requires an active interest not only of the individual but also of his social environment to modify the behavior. Aim: determine the relationship between perceived social support and adherence to therapy in patients who have been placed BIB. Methods: 75 obese (56 women and 19 men) between 18 and 65 years (M= 39.29, SD= 11.82), who attended five centers in the city of Caracas, where he carried out this procedure. Was used Social Support Scale and treatment adherence behavior respectively. The procedure was contacted the centers and the sample was selected. Subsequently, the inventories were applied before and the month after the before and three months after the balloon set. Results: Show that participants were characterized by moderate levels in the variables. On the other hand, those who perceive that they perceived support from friends are those who report adherence to therapy. Conclusions: From the results it is suggested promote social support networks, which could be essential to achieve and maintain adherence to therapy in patients with BioEnterics intragastric balloon.

Control personal de la conducta y adhesión terapéutica en balón intragástrico bioenterics / Personal control of behavior and adherence to therapy in intragastric balloon

Objetivo: Determinar la relación entre las habilidades de autorregulación, autoeficacia percibida, locus de control y la adhesión terapéutica en pacientes que se les ha colocado el balón intragástrico BioEnterics. Pacientes: Se incluyeron 75 obesos (56 mujeres y 19 hombres), entre los 18 y 65 años (M= 39,29; DT= 11,82), que asistieron a cinco centros de Caracas. Materiales y métodos: Se utilizaron los Inventarios de: autoeficacia percibida para el control del peso, auto-regulación y locus de control del peso corporal, y dos cuestionarios ad hoc, autoeficacia percibida para la adhesión al tratamiento farmacológico y de comportamientos de adhesión terapéutica. Inicialmente se contactó a los centros y se seleccionó la muestra. Posteriormente, se aplicaron los inventarios antes y al tercer mes posterior a la colocación del balón. Resultados: Las variables arrojaron niveles moderados. Quienes se sienten capaces de controlar su ingesta alimentaria y su actividad física y a la vez perciben que tienen las estrategias para lograrlo, son aquellos que reportan adhesión terapéutica. Conclusiones: A partir de estos resultados se sugiere entrenar habilidades de autorregulación y estimular las creencias de autoeficacia. Asimismo, se hace necesario estudiar la variable locus de control para aclarar su papel en la adhesión terapéutica.

Objective: Determine the relationship between the skills of self-regulation, self-efficacy, locus of control and adherence to therapy in patients who had been placed on bioEnterics intragastric balloon treatment. Patients: 75 obese (56 women and 19 men) between 18 and 65 years old (M = 39,29; SD = 11,82), who had been attended at five centers in Caracas city. Materials y methods: self-regulating body weight, perceived self-efficacy for weight control, Locus of control of weight and two ad hoc questionnaires, perceived self-efficacy for adherence to drug therapy and treatment adherence behavior respectively. The procedure was contacted the centers and the sample was selected. Subsequently, the inventories were applied before and three months after the balloon set. Results: Show that participants were characterized by moderate levels in the variables. On the other hand, those who feel able to control their food intake and physical activity at the same time perceive that they have the strategies to achieve it, are those who report adherence to therapy. The locus of perceived control seems to have no relationship. Conclusions: From the results it is suggested to train skills and boost self-efficacy beliefs. Also, it is necessary to study the locus of control variable to clarify its role in adherence to therapy in patients with BioEnterics intragastric balloon.

Segundo balón intragástrico para el tratamiento de la obesidad: experiencia preliminar / The second intragastric balloon for the treatment of the obesity: preliminary experience

El balón intragástrico bioenteric (BIB) es un procedimiento endoscópico, no quirúrgico indicado para el tratamiento temporal de la obesidad, que favorece la disminución de la capacidad gástrica, ocupando gran parte del fundus. Poca experiencia se ha publicado en la colocación de segundo balón intragástrico. Objetivo: Analizar la eficacia, seguridad y tolerabilidad de la colocación de segundo balón intragástrico. Métodos: Estudio retrospectivo, descriptivo y longitudinal, de Abril 2007 hasta Abril 2010, 10 pacientes, 7 mujeres, 3 hombres, con edad promedio de 39.4 en mujeres y 35,7 en hombres, con un rango desde 18 hasta 52 años y de intervalo de colocación de 10,4 meses. Resultados: La pérdida de peso promedio con el primer balón fue de 21.4 kg y la pérdida de peso con el segundo balón fue de 7.7 kg, con una diferencia de 13.7 kg en promedio. No hubo complicaciones severas. Conclusión: El segundo BIB no demostró en este grupo preliminar ser efectivo para la pérdida de peso.

The bioenteric intragastric balloon (BIB) is an endoscopic procedure, not surgically indicated for the temporal treatment of the obesity, which favors the decrease of the gastric capacity, occupying great part of the fundus. Few experience has been published in the placement of the second intragastric balloon. Objective: Analyze the efficacy, safety and tolerance of the placement of the second intragastric balloon. Methods: retrospective, descriptive, longitudinal study, from April 2007 to April 2010, 10 patients, 7 women, 3 men, with a mean age of 39.4 in women and 35,7 in men, with a range from 18 up to 52 years old and interval of placement 10,4 months. Results: The loss of mean weight with the first balloon was of 21.4 kg and the second balloon 7.7 kg, with a difference of 13.7 kg in average. There was no severe complications. Conclusion: The second BIB did not demonstrate in this preliminary group effectivity as the first one for the weight loss.

Therapeutic effects of Bioenterics Intragastric Balloon for obesity / 中华消化内镜杂志

Objective To study the therapeutic effects of Bioenterics Intragastric Balloon (BIB) on obesity under gastroscopy.Methods Data of 47 patients treated with Bioenterics Intragastric Balloon under gastrscopy were reviewed from July,2010 to May,2011.Results Weight loss ( mean 15.4 kg ) was successfully achieved in all the patients during 6 months.BMI decreased by 3.2-6.4 kg/m2 ( mean 4.7 kg/m2 ).There was no serious side effect with a better result for obesity according to the follow-up.Conclusion BIB is effective for obesity for noninvasiveness,stable speed of weight loss and less pain.

Balón intragástrico: una alternativa endoscópica en el tratamiento de la obesidad / Intragastric balloon: an endoscopic alternative in the treatment of obesity

El balón intragástrico bioenteric (BIB) es un procedimiento endoscópico, no quirúrgico indicado para el tratamiento temporal de la obesidad, que favorece la disminución de la capacidad gástrica, ocupando gran parte del fundus. Analizar la eficacia a corto plazo, seguridad y tolerabilidad del balón intragástrico en el tratamiento de la obesidad. Estudio retrospectivo, descriptivo y longitudinal, de abril 2005 hasta abril 2009, 141 pacientes, 121 mujeres, 20 hombres, 5 fueron segundo balón, 4 mujeres y 1 hombre, con un total de 146 balones colocados; con edad promedio de 37.2 en mujeres y 35,23 en hombres, con un rango desde 16 hasta 69 años y un tiempo promedio de duración del balón 6,94 meses. El peso promedio al inicio fue de 96.34 y al final de 82.01 kg, con una diferencia de 14.33 kg. En cuanto al Índice de Masa Corporal (IMC), el cambio observado fue un grado de diferencia, pasando de obesidad grado II a obesidad grado I. El valor promedio al inicio fue de 36.37 kg/m2 y al final 30.95 kg/m2. El promedio de grasa al inicio 40,97 Kg (42.55%) y al final 30.82 kg (36.63%). La co-morbilidad más frecuente fue: hiperinsulinismo 67(45.89%) dislipidemia 37(25.34%), hipertensión arterial 19 (13.01%). No hubo complicaciones severas. El BIB es un método endoscópico seguro y eficaz en el tratamiento de la obesidad...

The bioenterics intragastric balloon (BIB) is a non-surgical endoscopic procedure indicated for the temporary treatment of obesity, which subserves the reduction of gastric capacity, occupying most of the fundus. To analyze the short-term effi ciency, safety and tolerability of the intragastric balloon in the treatment of obesity. Retrospective, descriptive and longitudinal study, from April, 2005 to April, 2009. 141 patients, 121 women, 20 men; 146 BIB, 5 were second BIB, 4 women and 1 man; with an average age of 37.2 forwomen and 35,23 formen, with a range from 16-69 years and an average period of 6.94 months duration of the balloon. The average weight at the beginning was 96.34 kg and at the end 82.01 kg, with a difference of 14.33 kg. As for the Body mass index (BMI), the observed change was a 1 degree difference, passing from obesity degree II to obesity degree I. The average value at the beginning was 36.37 kg/m2 and at the end 30.95 kg/m2. The average of body fat at the beginning was 40,97 Kg (42.55%) and at the end of our study was 30.82 kg (36.63%). The most frequent comorbidity was: hyperinsulinism 67 (46.89%), dyslipidemia 37 (25.34%), hypertension 19 (13.01). There were no severe complications. BIB is a safe and effective endoscopic method in the treatment of obesity...