RESUMO
Background: Intragastric balloon (IGB) insertion is a safe and effective method for the treatment of obesity. The most common side effects of the balloon-therapy are nausea/vomiting and abdominal pain, acute pancreatitis has rarely been reported. Case Description: We present the case of a 28-year-old woman who underwent IGB insertion 9 months before onset of intense upper abdominal pain. We confirmed the diagnosis of acute pancreatitis by means of clinical symptoms, serological tests and cross-sectional imaging. Endoscopic removal of the balloon led to a complete resolution of the symptoms. Initial laboratory parameters were normal on admission, only the control of lipase and amylase levels led us to the diagnosis of pancreatitis. On imaging with computed tomography, the filling catheter of the balloon showed to be dislodged in the duodenum. After carrying out a systematic approach, other causes of pancreatitis were ruled out. Conclusions: Laboratory tests including amylase/lipase and adequate imaging should be considered in patients with relevant symptoms after gastric balloon insertion. A possible pathogenesis may be the direct compression and traumatic effect on the pancreas by the balloon or the dislodgement of the catheter into the duodenum and an obstruction/compression of the Papilla. Endoscopic removal of the balloon is not mandatory in every case, it should be decided individually.
RESUMO
OBJECTIVE: The efficacy of argon plasma coagulation (APC) on gastric antral vascular ectasia (GAVE) may be impaired over time and depends greatly on the application settings. Endoscopic band ligation (EBL) may be an alternative, but study on its efficacy is limited. This study aimed to evaluate and compare the clinical efficacy of APC and EBL in treating GAVE. METHODS: Changes in the need for blood transfusion, number of treatment sessions and hospitalizations were retrospectively assessed in 63 transfusion-dependent patients with GAVE (mean age: 67.1 y, 54.0% female) treated with either APC or EBL (45 and 18 patients, respectively) in four tertiary endoscopic centers. RESULTS: Both methods substantially increased hemoglobin levels and decreased patients' need for a transfusion (22.0 ± 4.0 g/L and -5.62 ± 2.30 units of packed red blood cells [RBC] with APC, and 27.4 ± 6.1 g/L and -4.79 ± 2.46 units of packed RBC with EBL), without a significant statistical difference between the methods. However, fewer EBL sessions were required both for the cessation of need for a transfusion compared with those for the resolution of GAVE lesions (0.90 ± 0.10 vs 1.69 ± 0.31, P = 0.028). CONCLUSIONS: Both APC and EBL are effective in GAVE treatment. EBL may be superior in terms of number of treatment sessions, but not in its influence on hemoglobin level and need for transfusion. Further prospective studies with large, homogeneous sample size and standardized APC settings are needed.
