Intragastric balloon insertion increases the frequency of erosive esophagitis in obese patients.

BACKGROUND: The BioEnterics intragrastric balloon (BIB) has been successfully used for treatment with BMI >35 or BMI >40. Gastroesophageal reflux (GER) symptoms are sometimes reported to occur and/or to worsen in patients with BIB, with a variable onset of erosive esophagitis (EE). The aim of this study was to investigate the prevalence and the severity of esophagitis after BIB placement. METHODS: 121 patients (93 F, 28 M, mean age 45 (19-65), mean BMI 41.5 (30-63.5) were studied. Patients with severe esophagitis (grade C-D Los Angeles (LA) classification), gastric or duodenal ulcers were excluded from the BIB treatment. After BIB placement, proton-pump inhibitors (PPI) were administered in the first month to each patient. The BIB was removed after 6 months. The presence of EE and related severity by LA classification were recorded RESULTS: Before BIB insertion, 18 patients (15%) showed mild EE (16 grade A and 2 grade B). After BIB removal, EE was observed in 22 patients (18.2%): 11 grade A, 7 grade B, 4 grade C-D. The difference in the prevalence of EE after BIB was statistically significant (Wilcoxon's test P =0.030). CONCLUSION: EE prevalence was significantly increased after BIB placement. We suggest that EE due to enhanced GER could be considered as an adverse effect of such treatment. We therefore recommend maintaining intragastric acid suppression with PPIs during the 6 months of BIB placement.

ASGE guidelines for the appropriate use of upper endoscopy: association with endoscopic findings.

BACKGROUND: This prospective study examined the appropriate use of EGD in an open-access system with the American Society for Gastrointestinal Endoscopy (ASGE) guidelines and determined whether the ASGE guidelines were associated with relevant endoscopic findings. METHODS: In a cohort of 1777 consecutive patients referred for open-access EGD, the proportion of patients who underwent EGD for appropriate indications was prospectively assessed. The relationship between appropriateness and the presence of clinically relevant endoscopic diagnoses was assessed by calculating (1) the likelihood ratio, positive and negative, of the indications; and (2) the change in the probability of relevant endoscopic diagnoses in the presence of the ASGE criteria. RESULTS: The rate for EGDs "generally not indicated" was 15.6%. Relevant endoscopic diagnoses were present in 47.4% of cases with ASGE indications versus 28.8% of patients without appropriate indications as defined by the ASGE criteria (OR: 2.23; 99% CI [1.55, 3.22]; p < 0.01). A similar difference was observed for erosive gastritis (OR: 1.86; 99% CI [1.17, 2.95]; p < 0.01), erosive esophagitis (OR: 1.48; 99% CI [0.87, 2.52]; p < 0.05), and Barrett's esophagus (OR: 9.76; 99% CI [0.72, 132]; p < 0.05). The pretest probability of finding a relevant endoscopic diagnosis was modified slightly when an ASGE indication(s) was present and decreased markedly when ASGE criteria were absent. CONCLUSIONS: The use of the ASGE guideline for appropriate indications for EGD can improve patient selection for the procedure. However, to avoid missed diagnoses of serious disease, use of the guidelines must be tailored to the specific clinical setting.