Epidemiology of the surgical management of obesity.

Surgical interventions for obesity have quintupled in the world in 15 years (140,000 in 2003 vs. 720,000 in 2018), however growth has slowed since 2011. This progressive increase varies by country and from 2008 through 2018, 6.5 million people have undergone bariatric surgery. Growth was strongest in the Asia/Pacific region. Belgium is the country performing the most operations per number of inhabitants: (127 operations per 100,000). France is in 7th place with 72 operations per 100,000 and 70% of patients are operated in surgical services that perform more than 100 procedures per year. The sleeve gastrectomy (SG) is the most commonly performed intervention while the adjustable gastric band (AGB) has practically disappeared. Along with the intragastric balloon, novel endoluminal procedures are being evaluated. A real management policy is needed to respond to this evolution of both epidemiology and techniques.

Assessment of the Quality and Reliability of Intragastric Balloon Videos on YouTube.

PURPOSE: There is no mechanism to control the accuracy and quality of videos on YouTube. However, it is essential to evaluate the quality of videos on YouTube to prevent patients from accessing misleading information. The aim of this study was to assess the quality and reliability of the videos available on YouTube concerning intragastric balloon. MATERIALS AND METHODS: YouTube was searched using the keywords "intragastric balloon" and "gastric balloon." A total of 158 videos were independently analyzed by two bariatric surgeons-endoscopists and were classified as reliable or non-reliable. Video demographics (view, view per day, like, dislike, comment) were analyzed according to the quality and source of the video. The video power index (VPI) was calculated for each video. The modified DISCERN and global quality scores (GQS) were used to rate the reliability and overall quality of the videos. RESULTS: Of the included videos, 63.9% were described reliable and 36.1% as non-reliable. The median number of dislikes, comments, views, views per day, and video duration on YouTube did not significantly differ between the two reliability groups. The mean length of the videos, GQS and DISCERN scores, and the median number of likes were significantly higher in the reliable group. The highest median VPI value was determined for the videos uploaded by TV programs. CONCLUSION: The number of reliable videos is higher than non-reliable about intragastric balloon on YouTube. However, the reliability and quality of the videos are generally low. The videos uploaded by TV programs are significantly more popular.

Cost-effectiveness of procedure-less intragastric balloon therapy as substitute or complement to bariatric surgery.

BACKGROUND: Procedure-less intragastric balloon (PIGB) eliminates costs and risks of endoscopic placement/removal and involves lower risk of serious complications compared with bariatric surgery, albeit with lower weight loss. Given the vast unmet need for obesity treatment, an important question is whether PIGB treatment is cost-effective-either stand-alone or as a bridge to bariatric surgery. METHODS: We developed a microsimulation model to compare the costs and effectiveness of six treatment strategies: PIGB, gastric bypass or sleeve gastrectomy as stand-alone treatments, PIGB as a bridge to gastric bypass or sleeve gastrectomy, and no treatment. RESULTS: PIGB as a bridge to bariatric surgery is less costly and more effective than bariatric surgery alone as it helps to achieve a lower post-operative BMI. Of the six strategies, PIGB as a bridge to sleeve gastrectomy is the most cost-effective with an ICER of $3,781 per QALY gained. While PIGB alone is not cost-effective compared with bariatric surgery, it is cost-effective compared with no treatment with an ICER of $21,711 per QALY. CONCLUSIONS: PIGB can yield cost savings and improve health outcomes if used as a bridge to bariatric surgery and is cost-effective as a stand-alone treatment for patients lacking access or unwilling to undergo surgery.

ASSESSMENT OF WEIGHT LOSS AFTER NON-ADJUSTABLE AND ADJUSTABLE INTRAGASTRIC BALLOON USE.

BACKGROUND: Intragastric balloon (IGB) use is indicated for patients whose BMI precludes the option of bariatric surgery or who need to lose weight prior to undergoing surgery. It is a minimally invasive procedure and currently there are two main models of IGBs in use, the non-adjustable intragastric balloon (NIB), implanted for six months, and the adjustable intragastric balloon (AIB), implanted for up to 12 months. OBJECTIVE: Analyze clinical characteristics between patients receiving non-adjustable gastric balloon and the adjustable (prolonged implantation) intragastric balloon. METHODS: This was a cross-sectional study of 470 patients diagnosed as obese or overweight who had balloon implantation from October 2011 to July 2018. The associations between percentage excess weight loss versus clinical and demographic variables were calculated using the chi-squared test. Independent samples were submitted to the Student's t test to determine the quantitative variables, with a confidence interval of 95%. Calculation of excess weight was based on an estimated ideal weight that would correspond to a BMI of 24.99 kg/m2. RESULTS: A total of 414 patients completed the treatment achieving an average total body weight loss (%TBWL) of 15.4±7 with the NIB and 15.5±9.6 with the AIB. Overweight patients achieved higher excess weight loss (%EWL) values using AIBs (157.2±82.5) and obese patients did so with NIB use (56±29.7). Women achieved higher %EWL values (65.6±62.2) than men (48±27.1). Individuals who attended >4 consultations with a nutritionist (60.8%) achieved TBWL >18%. All of those P-values were <0.001. CONCLUSION: Obese individuals and women registered the greatest weight losses. Overweight patients achieved greater losses using AIB and obese patients did so using NIBs. NIB use was associated with higher EWL percentages. Nutritional accompaniment had a positive impact on the %TBWL.

Avaliação de perda de peso após o uso de balão intragástrico não ajustável e ajustável / Assessment of weight loss after non-adjustable and adjustable intragastric balloon use

ABSTRACT BACKGROUND: Intragastric balloon (IGB) use is indicated for patients whose BMI precludes the option of bariatric surgery or who need to lose weight prior to undergoing surgery. It is a minimally invasive procedure and currently there are two main models of IGBs in use, the non-adjustable intragastric balloon (NIB), implanted for six months, and the adjustable intragastric balloon (AIB), implanted for up to 12 months. OBJECTIVE: Analyze clinical characteristics between patients receiving non-adjustable gastric balloon and the adjustable (prolonged implantation) intragastric balloon. METHODS: This was a cross-sectional study of 470 patients diagnosed as obese or overweight who had balloon implantation from October 2011 to July 2018. The associations between percentage excess weight loss versus clinical and demographic variables were calculated using the chi-squared test. Independent samples were submitted to the Student's t test to determine the quantitative variables, with a confidence interval of 95%. Calculation of excess weight was based on an estimated ideal weight that would correspond to a BMI of 24.99 kg/m2. RESULTS: A total of 414 patients completed the treatment achieving an average total body weight loss (%TBWL) of 15.4±7 with the NIB and 15.5±9.6 with the AIB. Overweight patients achieved higher excess weight loss (%EWL) values using AIBs (157.2±82.5) and obese patients did so with NIB use (56±29.7). Women achieved higher %EWL values (65.6±62.2) than men (48±27.1). Individuals who attended >4 consultations with a nutritionist (60.8%) achieved TBWL >18%. All of those P-values were <0.001. CONCLUSION: Obese individuals and women registered the greatest weight losses. Overweight patients achieved greater losses using AIB and obese patients did so using NIBs. NIB use was associated with higher EWL percentages. Nutritional accompaniment had a positive impact on the %TBWL.

RESUMO CONTEXTO: O uso do balão intragástrico (BIG) é indicado para pacientes cujo IMC contraindica a cirurgia bariátrica ou que necessitam perder peso antes da cirurgia. É um procedimento minimamente invasivo e atualmente existem dois modelos principais de BIG - o balão intragástrico não ajustável (BINA), implantado por seis meses, e o balão intragástrico ajustável (BIA), por até 12 meses. OBJETIVO: Analisar os fatores associados aos resultados clínicos comparando o uso de balão intragástrico não ajustável com o uso de balão intragástrico ajustável. MÉTODOS: Estudo transversal em 470 pacientes, com sobrepeso ou obesidade, submetidos ao tratamento entre outubro 2011 e julho de 2018. A associação entre as porcentagens da perda de excesso de peso (%PEP) e da perda do peso total (%PPT) com as variáveis demográficas e clínicas foram calculados com o teste qui-quadrado (P<0,05). Foi utilizado o teste t de Student para amostras independentes para comparar variáveis quantitativas, com IC 95%. O cálculo do excesso de peso foi estimado em peso ideal correspondente a um IMC de 24.99 kg/m2. RESULTADOS: Um total de 414 pacientes realizaram o tratamento até o final, com %PPT média de 15,4±7 no BINA e 15,5±9,6 no BIA. Os com sobrepeso apresentaram maiores %PEP no BIA (157,2±82,5) e os obesos maiores %PEP no BINA (56±29,7), com P<0,001. Mulheres (65,6±62,2) apresentaram maiores %PEP do que homens (48±27,1), com P<0,001. Os indivíduos que atenderam a >4 consultas com nutricionista obtiveram %PPT >18% (60,8%), com P<0,001. CONCLUSÃO: Obesos e mulheres tiveram maiores perdas ponderais. Maior perda de peso foi identificada em pacientes com sobrepeso que utilizaram BIA e em obesos os quais utilizaram BINA. O BINA esteve associado com maiores taxas de %PEP. O acompanhamento nutricional impactou positivamente na %PPT.

Incremental cost-effectiveness of evidence-based non-surgical weight loss strategies.

Recent medical advancements have led to new modes of treatment for non-surgical weight loss, including several new medications. Our aim was to conduct an incremental cost-effectiveness analysis for all commercially available, evidence-based non-surgical weight loss interventions for people with excess weight. We identified interventions through a systematic review of randomized controlled trials that reported weight loss 12 months from baseline. We then meta-analysed the results, sourced costs and performed an incremental cost-effectiveness analysis from the payer perspective. Cost-effectiveness was presented in terms of cost per kilogram lost and quality-adjusted life years (QALY) gained. We further performed sensitivity analyses on costs and duration of benefits, and a probabilistic sensitivity analysis. Ten interventions were identified for inclusion: six pharmaceutical products (Alli, Xenical, Qsymia, Contrave, Belviq and Saxenda), two lifestyle modification programmes (Weight Watchers Meetings and Online), one food replacement and lifestyle programme (Jenny Craig) and one intragastric balloon system (Orbera). At an incremental cost-effectiveness ratio of $30 071 per additional QALY gained, only Weight Watchers Meetings was cost-effective. Sensitivity analyses revealed that for the medications to become incrementally cost-effective, costs would have to decrease by as much as 91%. Results are highly dependent on duration that benefits are maintained. Despite several newly available interventions, Weight Watchers Meetings is currently the only evidence-based, commercially available, cost-effective option for non-surgical weight loss. Other interventions, specifically medications, are more effective but priced too high to be cost-effective.

Assessment of the Effect of Dietary Modifications and Bioenteric Intragastric Balloon Treatment on the Changes of Some Morphological and Biochemical Parameters in Obese Patients.

Obesity is the most common disease of affluence of the XXI century. According to WHO (World Health Organization), it is defined as a chronic metabolic disorder manifested by excessive accumulation of adipose tissue with high tendency for familial occurrence. According to WHO, obesity reaches epidemic proportions in many countries. High BMI (Body Mass Index) correlates with coexisting diseases. Traditional dietetic treatment often does not bring any results. A form of conservative (non-surgical) support for patients in fighting with obesity is the reduction of stomach volume by bioenteric intragastric balloon (BIB) treatment. The aim of the work was to develop a diet with anti-inflammatory properties, well-tolerated by the patients after BIB treatment. An American diet was modified by changing the composition of fatty acids, increasing anti-oxidative potential and adding synbiotics for patients treated with BIB. Chemical analysis of reconstructed food ratios of recommended diet was performed, analysing the content of micronutrients, composition of fatty acids, antioxidative capacity, reducing power and the content of polyphenols. Improvement in anthropometric measurement results and satisfying body weight loss were obtained, while preserving fat-free body mass. Improvement in the parameters of lipid metabolism was also observed, that is, decrease in total CH (cholesterol) and TG (triglycerides), and normalized concentration of HDL (high density lipoproteins) and LDL (low density lipoproteins) fractions. Reduced concentration of glucose in blood and lower blood pressure was also noted. Performed study confirms the effectiveness of complex treatment with BIB and properly adjusted individualized diet. Observations and own experience allow to deduce that patients who resign from systematic contact with a dietician cannot maintain reduced body weight. Abandoning previous habits is the only way to maintain the effect of weight loss. Most importantly, the change in patients' awareness and consequent behaviour in the future are crucial. Even though genes may contribute to obesity, environmental factors mainly determine the possibility of the disease to occur. Therefore, the change of patients' lifestyle after body weight reduction will decide on their fate.

Assessment of Weight Loss With the Intragastric Balloon in Patients With Different Degrees of Obesity.

INTRODUCTION: The intragastric balloon (IGB) is an endoscopic device for the treatment of obesity. Best results are observed in patients who follow a dietary program but few studies have assessed the results of this treatment in patients with different degrees of obesity. AIM: The aim of this study is to compare the efficacy of IGB in patients with different degrees of obesity. METHOD: A total of 2002 patients with IGB were retrospectively evaluated and were divided into groups according to initial body mass index (BMI) range, as follows: group 1, 27 to 29.9 kg/m; group 2, 30 to 34.9 kg/m; group 3, 35 to 39.9 kg/m; group 4, 40 to 44.9 kg/m; group 5, ≥45 kg/m. Weight was assessed in 3 different times: before (T0), 1 month (T1), 6 months (T2), and 6 months after removal of the IGB (T3). RESULTS: A total of 946 patients lost follow-up. Overall, 40 (3.78%) removed the device before programmed by intolerance, and 1016 patients completed the 6-month treatment. The mean weight loss was 18.9%, excess weight loss 60.1% and an BMI reduction of 6.76 points. 6 months after removal of the balloon 842 patients had continued follow-up (82.8%). At this time, weight loss was 19.84%, excess weight loss was 59.49%, and BMI reduction of 7.06 points. In all groups there was statistical difference between the times T0 and T1 and between T1 and T2 (P<0.001). There was no statistical difference between T2 and T3, in any group. CONCLUSION: IGB provided sustained weight loss in patients who remained in dietary follow-up for 1 year.

Novel technologies and techniques in bariatric surgery.

Obesity has been on the rise globally and more people are now clinically obese than ever before in the US. This issue has a significant impact on both health and cost to healthcare systems. Bariatric surgery is efficacious in treatment of obesity but only in late stages of the disease, and there is a requirement for less invasive techniques/devices to treat obesity at earlier stages. Currently a number of these are either in clinical trials or have recently been approved by the Food and Drug Administration for weight loss. This review aims to give an overview of the newer technologies and techniques being used in bariatric surgery. It will also give a glimpse into future methods and those that have fallen short in recent times.

Initial Approach to Childhood Obesity in Spain. A Multisociety Expert Panel Assessment.

PURPOSE: In recent years, the incidence of childhood obesity in Europe, and Spain in particular, has increased dramatically. Bariatric surgery could play a major role in treating of adolescents with severe obesity. However, no specific guidelines for bariatric surgery currently exist in Spain. METHODS: The Board of the Spanish Society for Obesity Surgery and Metabolic Diseases (SECO) proposed a study of childhood obesity by using the Delphi method. This prospective study involved 60 experts from nine national societies. Each society leader recruited experts from their society in obesity-related fields. Two online questionnaires were taken, and consensus on guidelines for various obesity treatments was reached according to the percentage of answers in favor or against inclusion of a given guideline. Based on these results, preoperative, surgical management and follow-up of childhood obesity management among others were analyzed. RESULTS: The survey results indicated significant concern among all societies regarding obesity. There was strong consensus with regard to adolescents and obesity, medical treatment, dietary recommendations, environmental and social factors, and goals for adolescents with obesity. Consensus on the use of intragastric balloons and other techniques was not reached. However, biliopancreatic diversion was rejected as a primary treatment, and mandatory psychological/psychiatric assessment was agreed upon. Inclusion criteria accepted were similar to those for adults with the exception of surgery in those with a body mass index <40. CONCLUSIONS: Spanish obesity-related societies are aware of the societal problem of childhood obesity. Multisociety development of national approaches may arise from consensus-building studies among specialists.

Informe rapido de balón intragástrico / Rapid report of intragastric balloon

FUNDAMENTO DE LA SOLICITUD:: Número de casos estimados por año: 60. Características de la población objetivo: -Obesos moderados con IMC 30-39,9, con riesgo de salud, pacientes con riesgo cardiovascular, hipertensos, etc.; -Obesos severos con IMC>40, con enfermedad asociada o previo a cirugía bariátrica para reducir el riesgo quirúrgico, no candidatos a cirugía por riesgo anestésico o por rechazar cirugía, DBT tipo II, mujeres en edad fértil para búsqueda de embarazo, pacientes con problemas ortopédicos o traumatológicos. TECNOLOGÍA REQUERIDA: Balón gástrico. ESTRATEGIA DE BÚSQUEDA DE LA EVIDENCIA CIENTÍFICA: Se realiza una una revisión de la literatura en las principales bases bibliográficas, pubmed, Cocrhane, Lilacs y Agencias de Evaluación de Tecnologías Sanitarias y Financiadores de Salud. Se priorizó la inclusión de informes de Evaluación de Tecnologías Sanitarias, Meta-Análisis y Revisiones Sistemáticas. DESCRIPCIÓN DE LA TECNOLOGÍA: Balón intragástrico: El balón intragástrico es un dispositivo no quirúrgico, que se implanta en el estomago de forma temporal para el tratamiento de la obesidad y ayudaría a conseguir pérdidas de peso significativas en un corto período de tiempo. Su mecanismo de acción está vinculado a la producción de sensación de saciedad o plenitud al ocupar parcialmente el estómago, provocando un descenso en el volumen de la ingesta de alimentos y podría, además, ayudar al paciente al aprendizaje de nuevos hábitos dietéticos y a la modificación de comportamientos. Existen varios tipos de balón intragástrico que difieren en el tipo de material, el volumen, la duración de la terapia, la capacidad de ajuste y el método de inserción y remoción. IMPORTANCIA SANITARIA DE LA CONDICIÓN CLÍNICA A LA QUE SE APLICA LA TECNOLOGÍA: La obesidad es un problema de salud crónico complejo, heterogéneo, de crecimiento y comportamiento epidémico que acorta la esperanza de vida, genera gran morbilidad y aumenta los costos socio-sanitarios. La guía de Evaluación y Tratamiento de la Obesidad elaborada por el Ministerio de Salud dela Nación, sugiere calcular el Índice de Masa corporal (IMC: peso en kilogramos dividido la altura en metros al cuadrado) en todos los adultos como principal medida antropométrica para el diagnóstico y clasificación de la obesidad. CONCLUSIONES: a. Seguridad: la mayoria de ́ los estudios reportaron tasas de efectos adversos más altas con el uso del balón respecto a los controles. Entre los efectos adversos reportados más frecuentemente se encuentran las náuseas, vómitos y dolor abdominal. Otros efectos adversos reportados incluyeron úlceras y erosiones gástricas. Los reportes adversos graves fueron poco frecuentes e incluyeron la migración del dispositivo, obstrucción intestinal, perforación gástrica y Sme de Mallory Weis. b. Eficacia/ Efectividad: el balón gástrico podría tener un rol de coadyuvante para lograr el descenso de peso mediante dieta y actividad física. La diferencia en la reducción de peso lograda con el dispositivo en comparación con otros métodos higiénicodietético no queda claramente establecida en virtud de las limitaciones metodológicas de los estudios que abordan el tema. Es necesario el desarrollo de estudios de mayor rigurosidad metodológica y períodos de seguimiento más largos. c. Utilidad clínica: El balón podría conseguir la pérdida de peso en pacientes obesos y con sobrepeso, pero no la magnitud de esta reducción en comparación con otras alternativas no está establecida como así tampoco el mantenimiento del descenso de peso a lo largo del tiempo luego del retiro del dispositivo. RECOMENDACIONES: La relación riesgo/beneficio del uso del balón intragástrico no se ha podido establecer de acuerdo a la bibliografía consultada. Es necesario contar con estudios de mayor rigurosidad científica para establecer y cuantificar los potenciales beneficios de su uso en relación al incremento de los efectos adversos.

Endoscopic Devices for Obesity.

The obesity epidemic, recognized by the World Health Organization in 1997, refers to the rising incidence of obesity worldwide. Lifestyle modification and pharmacotherapy are often ineffective long-term solutions; bariatric surgery remains the gold standard for long-term obesity weight loss. Despite the reported benefits, it has been estimated that only 1% of obese patients will undergo surgery. Endoscopic treatment for obesity represents a potential cost-effective, accessible, minimally invasive procedure that can function as a bridge or alternative intervention to bariatric surgery. We review the current endoscopic bariatric devices including space occupying devices, endoscopic gastroplasty, aspiration technology, post-bariatric surgery endoscopic revision, and obesity-related NOTES procedures. Given the diverse devices already FDA approved and in development, we discuss the future directions of endoscopic therapies for obesity.

Assessment of Predictive Response Factors to Intragastric Balloon Therapy for the Treatment of Obesity.

BACKGROUND: Obesity is a worldwide epidemic that is difficult to control with non-invasive treatments, which usually present poor results. In this context, the intragastric balloon (IGB) is an important tool that presents a mean body weight loss (BWL) estimated at approximately 12%, although individual responses are highly variable. OBJECTIVES: This study assesses whether there are factors that can predict responses to IGB therapy either before or early after placement of the device. MATERIALS AND METHODS: A total of 50 obese patients underwent insertion of IGB placed endoscopically, and patients were monitored for 6 months. The evaluated predictive factors involved general characteristics and psychological, social, and dyspeptic aspects, and the preliminary results obtained in the first month after balloon placement. RESULTS: The mean weight loss was 11.5%, and 48% of the participants presented BWL >10%. Among the factors analyzed before IGB placement, only advanced age (P = .04) and higher scores obtained in the social relationships domain of a shorter version of the World Health Organization's Quality of Life questionnaire (P = .02) were significant. Analysis of the factors evaluated after IGB placement revealed that the BWL amounts observed in week 2 (P = .001) and week 4 (P < .001) and the intensity of dyspeptic symptoms in week 2 (P < .001) were positive predictive factors. CONCLUSIONS: The assessment of predictive factors may help to manage patients with IGB.

The intra-gastric balloon for pre-operative weight loss in bariatric surgery: is it worthwhile?

BACKGROUND: Super-obese patients in NHS Lothian during 2009-2010 were offered the intragastric balloon to assist with weight loss prior to definitive bariatric surgery along with participation in a structured weight management programme. Those who declined balloon placement continued to receive weight management alone (WM). The aim of this study was to compare the effectiveness of the structured weight management programme with and without the addition of the intragastric balloon. METHODS: Patients referred to the NHS Lothian Bariatric Service in 2009 with BMI > 55 kg/m(2) or weight > 200 kg and assessed as otherwise eligible for bariatric surgery were offered structured weight management with or without placement of an intragastric balloon with the aim of achieving a target of 10 % excess weight loss (EWL) over 6 months. RESULTS: Twenty-eight patients were recruited. Fifteen opted for balloon placement and 13 declined. Three patients in the balloon group required early balloon removal due to intolerance and three dropped out of the WM group through non-attendance. Of those remaining, two in the balloon group and three in the WM group failed to achieve the 10 % EWL target. Overall, median %EWL was 17.1 % for the balloon group and 16.1 % for the WM group (p = 0.295, Mann-Witney U-test). CONCLUSIONS: The additional use of intragastric balloon conferred no benefit over structured weight management alone in achieving pre-operative weight loss in a super-obese patient population. In the context of limited resources within NHS Lothian, the continued use of intragastric balloon in this way cannot be justified.

[Endoscopic treatment of obesity]. / Tratamiento endoscópico de la obesidad.

Obesity is highly prevalent in many developed and developing countries and is on the increase. The range of obese patients suitable for endoscopic treatment may be very broad. The most widely applied treatment in Spain and elsewhere in Europe is the Allergan intragastric balloon. The effectiveness of this technique is good in the short-term but suboptimal in the long term and its safety profile is high. However, severe complications may occur and consequently the indication and implantation of this technique should not be trivialized. In addition, there are distinct endoscopic devices that help patients lose weight, through distinct mechanisms of action, but these devices are currently under technological development and awaiting scientific validation. It is too soon to recommend these techniques and they should only be evaluated in the context of clinical trials.

Balón intragástrico para el tratamiento de la obesidad mórbida / Intragastric balloon for the treatment of morbid obesity

CONTEXTO CLÍNICO: La obesidad es una condición cada vez más prevalente en todo el mundo. Se denomina obesidad mórbida cuando el índice de masa corporal (IMC) es mayor a 40, o cuando este supera los 35 pero el paciente presenta comorbilidades. En Argentina, la prevalencia de obesidad se encuentra entre 20 y 30%. Ser obeso se encuentra asociado a un incremento en la mortalidad, así como un aumento de la morbilidad asociada a osteoartritis, lumbalgia, diabetes, hipertensión, hernia hiatal, enfermedad vesicular, disnea e hipercolesterolemia. Además, la obesidad constituye un factor de riesgo independiente de enfermedad coronaria. En general, la obesidad es tratada principalmente con dietas, ejercicio físico y cambios en el estilo de vida. También se pueden utilizar drogas que reducen la absorción de grasas, o que alteran los niveles de noradrenalina y serotonina brindando sensación de saciedad. Sin embargo, en ocasiones, estos tratamientos no son efectivos, por lo que se ha propuesto la realización de tratamientos quirúrgicos cuyo objetivo es la reducción y mantenimiento posterior del peso mediante una restricción en la ingesta y/o absorción de alimentos. DESCRIPCIÓN DE LA TECNOLOGÍA: Diversas técnicas quirúrgicas han sido propuestas para el tratamiento de la obesidad mórbida. Entre ellas puede mencionarse principalmente al by-pass gástrico (variaciones de Roux-en-Y), la colocación de una banda en el estómago (ajustable o no ajustable), la gastroplastia vertical u horizontal, y la derivación biliopancreática con switch duodenal. Además, algunos de estos procedimientos pueden realizarse por vía laparoscópica o por vía convencional. El dispositivo Heliosphere Intragastric Ballon System ®, fue aprobado por el Sistema de Salud Canadiense en Diciembre del 2004. No está aprobado en USA por la FDA. CRITERIO DE BÚSQUEDA DE EVIDENCIA: Se realizó una búsqueda en las principales bases de datos bibliográficas (MEDLINE, Cochrane, DARE, NHS EED, Guidelines.gov, UpToDate ), en buscadores genéricos de Internet, agencias de evaluación de tecnologías sanitarias y financiadores de salud utilizando las siguientes palabras claves: "Gastric Balloon"[Majr] AND ("2002/05/30"[PDat] : "2012/05/26"[PDat] AND "humans"[MeSH Terms] AND (Clinical Trial[ptyp] OR Randomized Controlled Trial[ptyp]) AND English[lang]). RESULTADOS DE LA BÚSQUEDA: Las pruebas mostraron consistentemente pérdida de peso, mientras se someten a la terapia de balón intragástrico (con / sin terapias convencionales). Sin embargo, los tres pequeños los ensayos controlados aleatorios identificados no fueron concluyentes en cuanto a si los globos intragástricos son tan o más eficaz que las terapias convencionales sólo en ayudar a la pérdida de peso. La utilización de balones intragástricos no hizo ninguna diferencia a la pérdida de peso a largo plazo cuando los pacientes también sometieron a cirugía de la obesidad. CONCLUSIONES RELEVANTES: La implantación de un balón intragástrico constituye una intervención efectiva a corto plazo, de carácter no quirúrgica, para perder peso. Es menos segura que la terapia convencional. Se observaron las siguientes complicaciones graves, tales como muerte, obstrucción gastrointestinal, perforación gástrica, ruptura esofágica y biliar. Se observó pancreatitis en menos de 1 por ciento de los pacientes. Las complicaciones menores como náuseas y vómitos en(32 - 100% de los pacientes. Dos por ciento de los pacientes requiere la eliminación temprana del balón debido a la intolerancia. Dos estudios proporcionaron pruebas limitadas de que los pacientes hiperobesos han mejorado la seguridad resultados cuando reciben tratamiento con balón intragástrico antes de la cirugía de la obesidad, en relación con la cirugía sola. También es utilizado como prueba de compliance prequirúrgico. También es colocado como "puente" a la cirugía en casos de lista de prequirúrgicos alta, al ponerlos en lista de espera. La implantación del Balón está indicado por el término de seis meses en pacientes con BMI 30-40 kg/m2 que poseen factores de riesgos asociados a la obesidad. ( BMI mayor a 40 o BMI menor de 30 con riesgos psicológicos, que reúsan del acto quirúrgico o alto riesgo prequirurgico. (Puede utilizarse como paso previo a la cirugía bariátrica Puede causar dolor abdominal leve ó vómitos al ser llenado en su plenitud.( 10-84% de los pacientes), particularmente dentro de los 7 dias de instaurado el dispositivo . No se reportaron efectos adversos serios.: Otros descriptas fueron: reflujo esofágico, erosiones gástricas, formación de úlceras gastroduodenales, sangrado digestivo, ruptura del balón. Según la literatura fue removido por algunas de etas complicaciones en 3.4% al 8.5% de los balones colocados. . Reportes de gravedad como la obstrucción intestinal se encontró en el 0.3%- 4.8$ y perforación gástrica en el 2.9%.

A pathway to endoscopic bariatric therapies.

The American Society for Gastrointestinal Endoscopy (ASGE) is dedicated to advancing patient care and digestive health by promoting excellence in gastrointestinal endoscopy. The American Society for Metabolic and Bariatric Surgery (ASMBS) is dedicated to improving public health and well-being by lessening the burden of the disease of obesity and related diseases. They are the largest professional societies for their respective specialties of gastrointestinal endoscopy and bariatric surgery in the world. The ASGE/ASMBS task force was developed to collaboratively address opportunities for endoscopic approaches to obesity, reflecting the strengths of our disciplines, to improve patient and societal outcomes. This white paper is intended to provide a framework for, and a pathway towards, the development, investigation, and adoption of safe and effective endoscopic bariatric therapies (EBT).

Position of intragastric balloons in global initiative for obesity treatment.

Obesity is chronic disease with multiple health consequences and among the most severe health problems worldwide. According to public health records around 65% of population in Croatia are overweight and 20% obese. National physicians chamber with support of Health and Social Welfare Ministry gave recommendations on diagnosing and treating of obesity in form of national consensus. Treatment of obesity is complex and enrolls multiple clinical specialties. Change of life style, strenuous physical activity and pharmacotherapy are part of conservative treatments. Patients are treated more efficiently by minimally invasive endoscopic procedures or bariatric surgery depending on starting body mass index score. Implantation of intragastric balloons is conceptually simple method of obesity treatment. Modern devices as Bio-Enterics intragastric balloons (BIB), (Inamed Health, USA) are gaining wide popularity among both patients and physicians. BIB intragastric offers the best gains with individuals ranging BMI from 35 to 40. Efficiency has relative timeline dependance from 85% at 6 months to 24% at 36 months. BIB offers substantial ameliorative influence on obesity comorbidities, particularly cardiovascular risk. Treatment with BIB is also efficient but transient treatment modality in morbidly and superobese individuals to reduce preoperative risks of general and bariatric surgery. Obesity treatment with BIB is well tolerated and safe, offering better quality of life. Nevertheless, due to relative poor results of conservative obesity treatments on long-term follow up further investigations defining new clinical parameters for solving treatment resistance. In order to provide resourcefully individualized approach modern perspectives are focused on endocrine constitutes of obesity. Hormonal effects of BIB treatment in compare to bariatric surgery are potentially interesting for the prospect studies.