Spanish Intragastric Balloon Consensus Statement (SIBC): practical guidelines based on experience of over 20 000 cases

Background: intragastric balloons (IGBs) are a minimally invasive, increasingly popular option for obesity treatment. However, there is only one worldwide guideline standardizing the technical aspects of the procedure (BIBC, SOARD 2018). Objectives: to construct a practical guideline for IGB usage by reproducing and expanding the BIBC survey among the Spanish Bariatric Endoscopy Group (GETTEMO). Methods: a 140-question survey was submitted to all GETTEMO members. Twenty-one Spanish experienced endoscopists in IGBs answered back. Eight topics on patient selection, indications/contraindications, technique, multidisciplinary follow-up, results, safety, and financial/legal aspects were discussed. Consensus was defined as consensus ≥ 70 %. Results: overall data included 20 680 IGBs including 12 different models. Mean age was 42.0 years-old, 79.9 % were women, and the mean preoperative body mass index (BMI) was 34.05 kg/m². Indication in BMI > 25 kg/m², 10 absolute contraindications, and nutritional and medication measures at follow-up were settled. A mean %TBWL (total body weight loss) of 17.66 % ± 2.5 % was observed. Early removal rate due to intolerance was 3.62 %. Adverse event rate was 0.70 % and 6.37 % for major and minor complications with consensual management. A single case of mortality occurred. IGBs were placed in private health, prior contract, and with full and single payment at the beginning. Seven lawsuits (0.034 %) were received, all ran through civil proceeding, and with favorable final resolution. Conclusions: this consensus based on more than 20 000 cases represents practical recommendations to perform IGB procedures. This experience shows that the device leads to satisfactory weight loss with a low rate of adverse events. Most results are reproducible compared to those obtained by the BIBC (AU)

AGA Technical Review on Intragastric Balloons in the Management of Obesity.

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.

How young for bariatric surgery in children?

Obesity affects 50% of adults and 18% of children in the USA. It has wide-ranging comorbidities with clinical, psychosocial, and economic ramifications. Obesity refers to a condition of excess body fat. The basis for weight gain is a fundamental imbalance between caloric intake and output, but individual variation based on genetics, metabolism, and diverse environmental triggers is seen. Although modifications to our obesogenic society and education about the risks in our environment may lead to a decrease in the incidence of obesity through prevention, treatment for those already obese is critically important. In adults, the most successful treatment programs for obesity include a surgical procedure. This article discusses the problems obesity presents to children and their families, highlights the unique aspects of treating obesity in children, reviews the currently utilized bariatric surgical procedures, and introduces those bariatric procedures that are under development. When considering whether to use bariatric surgical procedures in a multidisciplinary weight management program for children, the special needs and characteristics of children with a severe weight problem must be considered. Development of bariatric surgical techniques and devices and implementation of these tools in multidisciplinary weight management programs need greater attention. This will require the combined efforts of the pediatric health care providers from many specialties and partnerships with industry to facilitate discovery and implementation.

Analysis of safety and efficacy of intragastric balloon in extremely obese patients.

BACKGROUND: The implantation of an intragastric balloon constitutes a short-term effective non-surgical intervention to lose weight. The aim of this study was to evaluate retrospectively the clinical outcome and safety of gastric balloon therapy (GBT) in extremely obese patients. METHODS: One hundred and nine super- and super-super-obese patients, 64 males and 45 females, mean age 39.1+/-8.4 years, mean body mass index (BMI) 68.8+/-8.9 kg/m2, who underwent GBT for weight loss, were studied retrospectively. GBT was assessed in massively obese patients concerning tolerance, weight loss, number of comorbidities and complications. RESULTS: A significant reduction in patients' weight and BMI was evident after GBT. Regarding safety, no major complications occurred. Minor complications at balloon placement and removal occurred in one (0.9%) and three patients (2.8%) respectively. Mean duration of GBT was 177.6+/-56.8 days. After GBT, the mean weight loss was 26.3+/-15.2 kg (p<0.001) and the mean BMI reduction was 8.7+/-5.1 kg/m2 (p<0.001) representing a mean percentage of excess BMI lost (%EBL) of 19.7+/-10.2. The highest BMI loss was observed in patients with BMI>80 kg/m2. A noteworthy improvement of comorbidities in 56.8% of the patients was also noted. Of the 109 patients, 69 received subsequent bariatric surgery. All the procedures were performed laparoscopically. Ten patients, with a mean BMI of 68.6+/-10.6 kg/m2 after the removal of the first BIB, received a second BIB resulting in a non-significant weight and BMI loss of 6.3+/-9.4 kg and 1.8+/-2.9 kg/m2, respectively. CONCLUSIONS: Our study indicates the safety and efficacy of GBT in extremely obese patients particularly as a first step before a definitive anti-obesity operation. GBT appears to be a safe, tolerable, and potentially effective procedure for the initial treatment of morbid obesity.

The BioEnterics Intragastric Balloon (BIB): how to use it.

BACKGROUND: The authors have been using the new saline-filled BioEnterics intragastric balloon (BIB) since 1995. METHODS: By now, more than 650 BIBs have been implanted on our Unit. RESULTS: Because of close collaboration between the engineers and the users, and after several modifications, an easy-to-use balloon is available. In addition, we have developed 3 instruments which provide easy and quick removal of the BIB. CONCLUSION: The device, supported by a competent motivated team, is another modality available for weight loss.

Cirugía bariátrica con banda gástrica ajustable / Bariatric surgery with adjustable gastric banding

Antecedentes: La obesidad es una enfermedad crónica, progresiva, multifactorial creciendo en proporciones epidémicas. La masiva, presenta elevados costos en la salud pública, y vinculada a enfermedades crónicas asociadas, llevan a prematura incapacidad y mortalidad. Objetivos: Analizar la experiencia de los primeros 100 pacientes obesos mórbidos (OM) y superobesos (SO) operados laparocópicamente con banda gástrica ajustable (BGAL). Lugar: Hospital Universitario y Práctica Privada. Material y métodos: Desde enero 1998 hasta abril 2000 se operaron 100 pacientes OM y SO. El 74 por ciento mujeres, 43 años promedio (16-60), 143 kg de peso promedio (93-280). 81,6 kg (34-208) de exceso, 233,5 por ciento del peso ideal e indice de masa (IMC) promedio 53,2 (35-89,3). El 55 por ciento IMC = a 50 (superobesos, supersuperobesos y triple obesidad) y el 13 por ciento = a 66 (triple obesidad). La técnica original con inicio del túnel sobre la curvatura menor a 2 cm del cardias y "gastrostenometer" (sensor electrónico) en los primeros 30 pacientes se modificó luego, permitiendo ahorrar tiempo quirúrgico, evitar complicaciones, obtener posición de la banda más alta y estable creando una bolsa superior de tamaño muy pequeño (15-20 cc). Resultados: Tiempo operatorio: 80 min (40-120) en los últimos 90 pacientes. Fueron convertidos 4 entre los primeros 20 casos. No huvo mortalidad y las complicaciones importantes fueron tardías, 2 deslizamientos gástricos ("slippage") y 2 infecciones del reservorio (portacath). Seguimiento: 10 meses promedio (1-27), obteniéndose disminución del porcentaje del exceso de peso y del IMC (pre 53,2) a los 3 meses de 26 por ciento y 47, a los 6 de 43 por ciento y 41, a los 12 de 61 por ciento y 37, y a los 24 de 68 por ciento y 32. No hubo diferencias en porcentaje del peso perdido entre obesos mórbidos y superobesos. Enfermedades asociadas: descenso en número y severidad, del 33 por ciento en hipertensión arterial, 89 por ciento en síndrome de hipoventilación alveolar, 82,5 por ciento en diabetes y 86 por ciento en reflujo gastroesofágico, con mejoría global e importante en la calidad de vida. Conclusiones: Los resultados parecen promisorios, pero es necesario un seguimiento prolongado para establecer resultados fidedignos. La BGAL es un procedimiento laparoscópico de avanzada y los buenos resultados requieren una técnica segura y estandarizada

Cirugía bariátrica con banda gástrica ajustable / Bariatric surgery with adjustable gastric banding

Antecedentes: La obesidad es una enfermedad crónica, progresiva, multifactorial creciendo en proporciones epidémicas. La masiva, presenta elevados costos en la salud pública, y vinculada a enfermedades crónicas asociadas, llevan a prematura incapacidad y mortalidad. Objetivos: Analizar la experiencia de los primeros 100 pacientes obesos mórbidos (OM) y superobesos (SO) operados laparocópicamente con banda gástrica ajustable (BGAL). Lugar: Hospital Universitario y Práctica Privada. Material y métodos: Desde enero 1998 hasta abril 2000 se operaron 100 pacientes OM y SO. El 74 por ciento mujeres, 43 años promedio (16-60), 143 kg de peso promedio (93-280). 81,6 kg (34-208) de exceso, 233,5 por ciento del peso ideal e indice de masa (IMC) promedio 53,2 (35-89,3). El 55 por ciento IMC = a 50 (superobesos, supersuperobesos y triple obesidad) y el 13 por ciento = a 66 (triple obesidad). La técnica original con inicio del túnel sobre la curvatura menor a 2 cm del cardias y "gastrostenometer" (sensor electrónico) en los primeros 30 pacientes se modificó luego, permitiendo ahorrar tiempo quirúrgico, evitar complicaciones, obtener posición de la banda más alta y estable creando una bolsa superior de tamaño muy pequeño (15-20 cc). Resultados: Tiempo operatorio: 80 min (40-120) en los últimos 90 pacientes. Fueron convertidos 4 entre los primeros 20 casos. No huvo mortalidad y las complicaciones importantes fueron tardías, 2 deslizamientos gástricos ("slippage") y 2 infecciones del reservorio (portacath). Seguimiento: 10 meses promedio (1-27), obteniéndose disminución del porcentaje del exceso de peso y del IMC (pre 53,2) a los 3 meses de 26 por ciento y 47, a los 6 de 43 por ciento y 41, a los 12 de 61 por ciento y 37, y a los 24 de 68 por ciento y 32. No hubo diferencias en porcentaje del peso perdido entre obesos mórbidos y superobesos. Enfermedades asociadas: descenso en número y severidad, del 33 por ciento en hipertensión arterial, 89 por ciento en síndrome de hipoventilación alveolar, 82,5 por ciento en diabetes y 86 por ciento en reflujo gastroesofágico, con mejoría global e importante en la calidad de vida. Conclusiones: Los resultados parecen promisorios, pero es necesario un seguimiento prolongado para establecer resultados fidedignos. La BGAL es un procedimiento laparoscópico de avanzada y los buenos resultados requieren una técnica segura y estandarizada (AU)

Gastric distension, hunger and energy intake after balloon implantation in severe obesity.

OBJECTIVE: To investigate the interrelationships between satiety feelings, abdominal perception, energy intake and weight loss, related to the presence of an intragastric balloon. DESIGN: Randomized double blind study. SUBJECTS: 20 severely obese subjects, BMI > 40 kg/m2, randomly assigned either to receive an air filled balloon (n = 11) or to have a sham procedure (n = 9). All subjects had dietary counselling to help them follow a relatively low energy diet (60% of individual spontaneous intake). MEASUREMENTS: During biweekly visits, body weight was recorded, visual analogic scales for stomach distension, hunger and feeling of balloon presence were completed. Blood chemistry profiles were monitored once every 4 weeks. RESULTS: In the balloon group, the sensations related to the presence of the balloon and to abdominal distension dramatically increased after insertion, and plateaued during the next 4 weeks. Both feelings of presence and distension decreased thereafter, and after 10 weeks they were not significantly different from those of the sham balloon group. Hunger dramatically decreased to about 30% of initial rating in the first week, but slowly returned to the initial value by the 12th week. Hunger feelings were highly and negatively correlated with feelings of distension. During the same period, the sham balloon group continued to maintain the low energy intake, and did not register any feelings of distension or presence; hunger level did not differ from initial levels throughout the whole study. The energy intake and the rate of weight loss (8-9 kg) was similar in the two groups during the study, and were not correlated with the feelings of distension. CONCLUSION: This study showed that in severely obese subjects submitted to a restrictive diet, an intragastric balloon has a measurable but transient effect on the sensation of epigastric distension and is able to decrease feelings of hunger. Unfortunately, these effects were not associated with a lower energy intake or a higher rate of weight loss than the sham situation. Thus, the present study does not support the interest of such a balloon (500 ml, air filled) in the treatment of severe obesity.