Brazilian Intragastric Balloon Consensus Statement (BIBC): practical guidelines based on experience of over 40,000 cases.

BACKGROUND: Intragastric balloons (IGBs) are a minimally invasive option for obesity treatment, acting as a space-occupying device and leading to weight loss through increased satiety. This device has been growing in popularity owing to its safety profile and good weight loss results. However, there are no published guidelines that standardize the technical aspects of the procedure. OBJECTIVES: To create a practical guideline for intragastric balloon usage. SETTING: Private and Academic Settings, Brazil. METHODS: A consensus meeting was held in São Paulo, Brazil, in June 2016, bringing together 39 Brazilian endoscopists with extensive experience in IGBs from all regions of the country. Topics on patient selection, indications, contraindications, multidisciplinary follow-up, technique, and adverse events were discussed in the form of questions. After electronic voting, a consensus was defined when there was ≥70% agreement. Experts were also requested to provide data on their experience with IGBs. RESULTS: The selected experts discussed and reached a consensus on 76 questions, mainly concerning specific indications and contraindications for the procedure; technical details, such as patient preparation, minimum balloon-filling volume, techniques for implant and explant; patient follow-up and recommended medication for the adaptation period; and adverse event management. The overall Brazilian expert data encompassed 41,863 IGBs, with a mean percentage total weight loss of 18.4% ± 2.9%. The adverse event rate after the adaptation period was 2.5%, the most common being hyperinflation (.9%) and spontaneous deflation (.8%) of the device. The early removal rate due to intolerance was 2.2%. CONCLUSIONS: The present consensus represents practical recommendations for performing IGB procedures and reflects Brazil's significant experience with this device. The experience of over 40,000 cases shows that the device leads to satisfactory weight loss with a low rate of adverse events.

Ulcer and bleeding complications and their relationship with dyspeptic symptoms in NSAIDs users: a transversal multicenter study.

OBJECTIVES: To evaluate the prevalence of lesions and digestive complications secondary to the use of non-steroidal anti-inflammatory drugs (NSAIDs), the clinical profile seen for digestive complaints and the relation with the endoscopic findings. METHODS: Prospective, multicentric, open study, evaluating consecutively 1231 patients, divided as follows: group I - NSAID and group II - non-NSAID. All patients answered questionnaire to evaluate the onset, the type of clinical complaint, the use of medication and possible complications associated to digestive bleeding. RESULTS. A total of 1213 patients were evaluated. Among them, 65% were female and 13.1% were smokers; 15.6% mentioned they ingested alcoholic beverages. The main signs and symptoms reported were epigastralgy and pyrosis (67% and 62%, respectively). The upper gastrointestinal (UGI) endoscopy was normal in 3.9% in group I and in 10.7% in group II (p < 0.001). Patient who do not use NSAID will be 2.5 times more likely to have normal UGI endoscopy (p = 0.001). The presence of erosive or ulcer lesions in the stomach and duodenum was more frequent in group I. The incidence of lesions in the stomach when compared to the duodenum is observed (erosions: 49.12% vs. 13.60%, p = 0.001; ulcers: 14.04% vs. 11.84%, p = 0.05). The risk of digestive bleeding is 12 times higher (6.14% vs. 0.51%) in those who used NSAIDs, and the stomach is the site in which bleeding occurs more frequently. Conclusions. The frequency of gastric ulcer, duodenal ulcer and digestive bleeding was higher in patients who used NSAIDs. There was no connection found between endoscopic findings and dyspeptic symptoms.

High definition endoscopy and "narrow band imaging" in the diagnosis of gastroesophageal reflux disease.

INTRODUCTION: The gastroesophageal reflux disease is a common condition in the western world but less than half of patients present endoscopic abnormalities, making a standard procedure unsuitable for diagnosis. High definition endoscopy coupled with narrow band imaging has shown potential for differentiation of lesions and possible biopsy, allowing early diagnosis and treatment. METHODS: This review describes the principles of biotic and their influence in obtaining images with better definition of the vessels in the mucosa, through the narrow band imaging. Selected papers using it in patients with reflux disease and Barrett's esophagus are analyzed in several ways, highlighting the findings and limitations. CONCLUSION: The meaning of the narrow band imaging in the endoscopic diagnosis of reflux disease will be defined by large scale studies, with different categories of patients, including assessment of symptoms and response to treatment.

High definition endoscopy and "narrow band imaging" in the diagnosis of gastroesophageal reflux disease / Diagnostico da doenca do refluxo gastroesofagico com endoscopia de alta definicao e "narrow band imaging"

Introduction: The gastroesophageal reflux disease is a common condition in the western world but less than half of patients present endoscopic abnormalities, making a standard procedure unsuitable for diagnosis. High definition endoscopy coupled with narrow band imaging has shown potential for differentiation of lesions and possible biopsy, allowing early diagnosis and treatment. Methods: This review describes the principles of biotic and their influence in obtaining images with better definition of the vessels in the mucosa, through the narrow band imaging. Selected papers using it in patients with reflux disease and Barrett's esophagus are analyzed in several ways, highlighting the findings and limitations. Conclusion: The meaning of the narrow band imaging in the endoscopic diagnosis of reflux disease will be defined by large scale studies, with different categories of patients, including assessment of symptoms and response to treatment. .

Introdução: A doença do refluxo gastroesofágico é condição altamente prevalente no mundo ocidental, porém, em menos da metade dos pacientes há alguma alteração endoscópica, indicando que a endoscopia convencional não é o procedimento ideal para o diagnóstico da doença do refluxo gastroesofágico. A endoscopia com aparelhos de alta definição associado ao dispositivo "narrow band imaging" tem demonstrado aplicação na diferenciação de lesões benignas das malignas e a possibilidade de direcionar as biópsias, permitindo diagnóstico e tratamento especialmente nos casos de câncer precoce. Método: Esta revisão descreve os princípios ópticos e sua influência na obtenção de imagens de vasos na mucosa, através da "narrow band imaging". Foram utilizados os descritores para pesquisa no PubMed e as publicações analisadas em diversos aspectos com destaque para o "narrow band imaging", seus fundamentos, aplicações e limitações. Conclusão: O significado do "narrow band imaging" no diagnóstico endoscópico da doença do refluxo gastroesofágico será definido por estudos em larga escala, com categorias diferentes de pacientes, incluindo avaliação de sintomas e resposta ao tratamento. .